The impact of intraoperative adverse events on orthopaedic surgery residents


  • Madeline M. Lyons Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood IL, USA
  • Haley E. Smith Department of Orthopaedic Surgery, Northwestern University, Chicago IL, USA
  • Kamran S. Hamid Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood IL, USA
  • Adam P. Schiff Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood IL, USA



Intraoperative adverse events, Surgical complications, Second victim, Orthopaedic surgery residency


Background: The goal of this study was to quantify the impact of intraoperative adverse events on orthopaedics residents to better understand how these occurrences affect resident training. Additionally, the study identified the emotional toll of adverse events on trainees and barriers to reporting.

Methods: An anonymous 26 question web-based survey was adapted from the Boston intraoperative adverse events surgeons’ attitude study (BISA) survey to be applicable to orthopaedic residents. The survey was sent to orthopaedic residency program coordinators listed in the Council of Orthopaedic Residency Directors (CORD) database. The coordinators then distributed the survey to each program’s residents and fellows.

Results: 77 orthopaedic residents and fellows completed the survey. Almost all (84.4%) reported having been involved in an IAE during their training, and the majority (80.6%) experienced emotional distress as a result. 50.7% of respondents have never been involved in discussions with patients or their family regarding a complication during their training.

Conclusions: The majority of residents have experienced emotional distress following an intraoperative adverse event, but residents are not routinely involved in subsequent discussions with patients and families following complications. This represents a significant area for improvement in both supporting and training surgical residents.


Mavros MN, Velmahos GC, Larentzakis A, Yeh DD, Fagenholz P, de Moya M, et al. Opening Pandora’s box: understanding the nature, patterns, and 30-day outcomes of intraoperative adverse events. Am J Surg. 2014;208(4):626-31.

Shanafelt TD, Balch CM, Bechamps G, ussell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.

Marmon LM, Heiss K. Improving surgeon wellness: The second victim syndrome and quality of care. Semin Pediatr Surg. 2015;24(6):315-8.

Han K, Bohnen JD, Peponis T, Martinez M, Nandan A, Yeh DD, et al. The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons’ Attitude (BISA) Study. J Am Coll Surg. 2017;224(6):1048-56.

Bohnen JD, Lillemoe KD, Mort EA, Kaafarani HMA. When Things Go Wrong: The Surgeon as Second Victim. Ann Surg. 2019;269(5):808-9.

Krueger CA. CORR Insights®: How Do Areas of Work Life Drive Burnout in Orthopaedic Attending Surgeons, Fellows, and Residents? Clin Orthop Relat Res. 2021;479(2):263-5.

Ames SE, Cowan JB, Kenter K, Emery S, Halsey D. Burnout in Orthopaedic Surgeons: A Challenge for Leaders, Learners, and Colleagues: AOA Critical Issues. J Bone Joint Surg Am. 2017;99(14):e78.

Somerson JS, Patton A, Ahmed AA, Ramey S, Holliday EB. Burnout Among United States Orthopaedic Surgery Residents. J Surg Educ. 2020;77(4):961-8.

Balogun JA, Bramall AN, Bernstein M. How Surgical Trainees Handle Catastrophic Errors: A Qualitative Study. J Surg Educ. 2015;72(6):1179-84.

Tan H. Debriefing after Critical Incidents for Anaesthetic Trainees. Anaesthesia and Intensive Care. 2005;33(6):768-72.

Herring JA. Complications: Second Victim. J Pediatr Orthop. 2020;40(1):S22-4.

Patel AM, Ingalls NK, Mansour MA, Sherman S, Davis AT, Chung MH. Collateral damage: the effect of patient complications on the surgeon’s psyche. Surgery. 2010;148(4):824-8.

Newcomb AB, Liu C, Trickey AW, Dort J. Tell Me Straight: Teaching Residents to Disclose Adverse Events in Surgery. J Surg Educ. 2018;75(6):e178-91.

Chambers CC, Ihnow SB, Monroe EJ, Suleiman LI. Women in Orthopaedic Surgery: Population Trends in Trainees and Practicing Surgeons. J Bone Joint Surg Am. 2018;100(17):e116.






Original Research Articles