SS20 - Post-Operative Complications and Their Association with Post-Traumatic Stress Disorder in Academic Vascular Surgeons

Objectives: Post-operative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons.

Methods: An anonymous electronic survey was sent to all vascular surgery program directors in North American with a request to disseminate to their faculty. The survey captured data on demographics, practice type, and used imbedded validated measures to determine emotional responses to post-operative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Logistic regression analysis was performed for all covariates found significant on univariate analysis.

Results: The survey was distributed to 229 faculty at 27 institutions and completed by 65 (response rate: 32%). 20/65 (31%) identified as female and the total group had an average age of 47. Most respondents (43/65, 66%) reported a major complication within 3 months of the survey, and the majority (45/65, 69%) reported the outcome of this was patient mortality. Of respondents, 20/65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year with 12/65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to use alcohol/other substances (p=0.0005) and criticize/blame themselves following the complication (p=0.0028); less likely to identify the complication as “expected” (p=0.048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs. 20%, p=0.008). In regard to support following major complications, most respondents (57/65, 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and sense of honor (66%). Gender differences persisted on multivariate analysis (p=0.016).

Conclusions: Emotional responses following major post-operative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly in complications that are not expected or in cases in which the cause of the complications was not a result of the patient or external factors. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described. Gender-related differences may exist, and most surgeons desire a support network of respected peers, with whom to discuss complications.