Microvascular Surgeons: The Second Victim in Free Flap Failure

Introduction: Second Victim Syndrome (SVS) is when a health care provider involved in a patient complication is traumatized by the event, manifesting as symptoms of anxiety, depression, and shame. We investigated microvascular surgeons' emotional response to free flap failure and their emotional support system.

Methods: A 20-question survey of microvascular surgeons was used. Questions focused on participant demographics and practice dynamics, surgeon emotional response to free flap failure, and participants’ emotional support systems.

Results: Eighty-four microvascular surgeons completed the survey. The majority were age 36-45 (56%); 60% were male and 39% female. White, non-Hispanic was the most common ethnicity (65%). There was even geographic distribution. Most (83%) practiced in an academic setting. The average years of practice was 9.1 + 8.6. Respondents’ most recent flap failure occurred within the last 6 months (39%), greater than 1 year (35%), and between 6 months and 1 year (24%).

Over half of surgeons reported anxiety (74%), guilt (71%), sadness (67%), shame or embarrassment (62.4%), and doubt (51.8%) following flap failure. Women were statistically more likely to endorse sadness (82% vs 56%, p = 0.03). Over half of respondents reported hypervigilance about future complications (62%), feeling judged by one’s colleagues (55%), and difficulty sleeping (50%). Women were more likely to endorse feelings of doubt of their surgical acumen after flap failure (64% vs. 34%, p = 0.01).

Respondents rated the quality of their emotional support systems on a 1-10 scale (1 no support at all, 10 best possible support). On average, a significant other or family was rated highest at 8.2/10, with other microvascular surgeons of similar experience a close second at 8/10. Female identifying surgeons reported lower support from non-medical friends compared to their male-identifying counterparts (p = 0.024, effect size = 0.273).

Conclusions: Flap failure results in SVS for microvascular surgeons of all ages, gender, and geographic distributions. Respondents have identified various support systems to process the negative emotions.