The physical and emotional impact of serious adverse patient events on neurosurgeons

Serious adverse patient events (SAPEs) can result in secondary traumatic stress (STS) among healthcare providers, leading to physical and emotional responses and maladaptive behaviors that can ultimately lead to increased healthcare costs and an increased risk for subsequent SAPEs. These responses have not been previously examined specifically among neurosurgeons; therefore, the authors herein undertook a survey of neurosurgeons to elucidate these responses.

Neurosurgeon members of the AANS were invited, via email, to complete an online mixed-methods survey that asked questions about the STS from their most significant SAPE and the trajectory of their STS over time. The survey included questions from validated tools for surveying depression, anxiety, and posttraumatic stress disorder. At the end of the survey, respondents were asked about their willingness to participate in a semi-structured qualitative televideo interview to further understand their experiences.

Eighty-seven online surveys were received (response rate 1.2%), and 5 televideo interviews were conducted. All respondents had experienced ≥ 1 SAPE; 98.9% had experienced one or more physical, cognitive, and/or emotional responses within the first 2 weeks after the event. STS from the most serious or emotionally impactful SAPE lasted a median of 6 months; 45.4% of respondents with available data reported an ongoing impact. The median severity of STS during the first 2 weeks postevent was 4 on a 6-point Likert scale (6, extreme impact). Almost two-thirds of respondents believed that their STS impacted their professional and personal performance during the first 2 weeks, and 71.7% believed it increased the risk of subsequent events during the first month after the event. STS was greater if the SAPE resulted from the respondent's action or inaction. The severity of the response increased with the seriousness of patient harm, the degree of personal responsibility, and litigation. Coping strategies most frequently included talking with others (colleagues, spouse or partner, family, friends), problem-solving to prevent recurrences, positive self-talk, exercise, hobbies or other activities, meditation or mindfulness, decreased work hours, and consulting with a spiritual advisor. Quality improvement conferences and litigation or the fear of litigation increased STS. Most respondents were unaware of any institutional support for STS. Almost half of respondents indicated that STS to subsequent SAPEs improved over their careers; another 42.2% reported no change. Notably, nearly one-third of respondents considered changing their employment or profession or made serious efforts to do so.

STS may be a significant issue for a proportion of neurosurgeons, although the generalizability of the study findings is limited considering the low response rate. Recommendations to mitigate the effects of STS are reported.