STEPFORWARD: A randomised controlled trial and economic evaluation of the impact of a hydraulic self-aligning ankle-foot on quality of life for patients with a below-knee amputation who have limited mobility – Trial overview

Surgeons will inevitably face an adverse event at some point during their careers. Adverse events can be conceptualised broadly as ‘any serious or significant event during surgical care that causes the surgeon significant distress’1 and can cover a whole spectrum of events, including surgical complications and surgical errors. Sadly, these events are common and inescapable- in a recent survey, 80% of surgeons (across levels of seniority) reported experiencing an interoperative adverse event in the last year2. Of course, the primary focus following an adverse event should be sensitive in addressing the impact for the patient and their family. However, surgeons are profoundly affected too; in a survey of surgeons’ experiences following an adverse event (n=445) 48% reported increased anxiety, 43% reported problems sleeping, 15% reported relationship difficulties, and around a third reported clinical levels of post-traumatic stress3,4. Adverse events in healthcare workers are also linked to reduced confidence, lower work performance, increased absenteeism, and, in extreme cases, suicide5.

It is perhaps surprising then, that there is often little preparation, training, or support, for surgeons around adverse events- particularly focusing on how to navigate these events and their psychological impact. Surgeons generally report feeling under prepared for adverse events by their training, and particularly ill-prepared for dealing with errors4. Surgeons may be more equipped practically for what an adverse event might look like, than for the ‘felt sense’, or personal impact, that an adverse event might have- the distress, guilt, shame, anger, sadness, sense of ‘failure’, the rumination about the impact for the patient, the ‘what could I have done differently?’, the ‘what does this say about me?’… and the impact on relationships within the team, such as perceived credibility and competence.