The way we see it: Surgeons' perceptions of perioperative events

Objectives: The objective of this study was to examine gynecologic (GYN) surgeons' perceptions of perioperative events and their severity. Secondarily, differences in perceptions between surgeons performing elective and nonelective surgery were compared. Design: Fifty-seven perioperative scenarios associated with GYN surgery were created. The scenarios were grouped into 16 broader categories (e.g., vascular injury, neuropathy). Scenarios were electronically distributed to GYN surgeons from geographically diverse areas, and surgeons classified each scenario as either a complication or a routine perioperative event. Surgeons rated complication severity using both a numerical rating scale (1-100) and the Clavien-Dindo scale (I-V). Study participants were divided into two groups based on whether they performed elective or nonelective surgeries. Materials and Methods: PASW ^® version 18 was used to calculate means, standard deviations, intraclass correlation coefficients (ICC), and coefficients of variability (Cv) for severity rankings of each scenario within and among surgeon groups. Results: Sixty-three out of 82 surgeons (77%) responded. GYN oncologists classified conversion from laparoscopy to laparotomy, blood transfusion, and delayed return of bowel function as complications less frequently than did surgeons who performed elective surgery (36% vs. 12%, p=0.02; 62 vs. 29%, p=0.003; 85% vs. 57%, p=0.002). Urogynecologists rated postoperative urinary symptoms as more severe complications than did other surgeon groups. All groups showed high agreement (96%-100%) classifying postoperative events involving foreign body (mesh, suture) as complications (Cv=46[30-51]). Conclusions: Surgeons' perceptions of perioperative events vary based on surgical indication and subspecialty training. Future studies assessing agreement between patients and surgeons' perceptions may aid in creating a patient-oriented GYN complication assessment tool.