The psychological impact of surgical complications on patients and surgeons

Abstract

Adverse events constitute a significant challenge for healthcare organisations not only in terms of their prevention but also in terms of their after-effects on the injured patients and the staff involved. This PhD aims to investigate the psychological impact of surgical complications on patients and surgeons on the basis that the operating room is one of the highest risk areas for serious adverse events. Chapter 1 presents background literature on the aftermath of patient safety incidents both from the patients’ and the healthcare professionals’ perspectives and outlines the gaps of knowledge in this area. Chapter 2 sets the scene for surgical complications and presents the limited existing data on patients’ and surgeons’ experiences of surgical adverse events. Chapter 3 provides an overview of relevant theoretical frameworks for the investigation and discussion of the psychological impact of surgical complications on patients and surgeons. A systematic review of the literature on the psychosocial impact of surgical complications on patients follows in Chapter 4. Chapters 5 and 6 present two empirical studies on surgeons’ experiences of surgical complications. Chapter 5 reports an interview study with 27 surgeons which yielded a range of themes relevant to the personal and professional impact of complications on surgeons, the factors that affect their reactions, their coping, their perceptions of support as well as their perceptions of the institutional cultures in the aftermath of serious complications. Chapter 6 presents a cross-sectional survey study, which aims to quantify the psychological effects of serious surgical complications on surgeons and to identify their psychosocial correlates. Chapters 7 and 8 focus on patients’ experiences of surgical complications. A two time-points interview study with 17 surgical patients who experienced complications of various levels of severity is reported in Chapter 7. This study presents findings relevant to the psychosocial effects of surgical complications on patients, the factors that affect their reactions as well as issues of patient-surgeon communication around complications. Informed by the findings of the systematic review, the patient interview study and relevant literature, a longitudinal cohort study on the psychological impact of surgical complications on patients and the psychosocial predictors of this impact is presented in Chapter 8. Chapter 9 presents an online survey study with patient safety managers on the management of the aftermath of serious patient safety incidents in the NHS. This study investigates how the aftermath of patient safety incidents is managed by NHS organisations and describes the support that is typically available to patients and healthcare staff. Chapter 10 ends with an overview of the key findings from each study, their methodological limitations, directions for future research and implications for supporting surgeons and patients in the aftermath of surgical complications.