American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

New Crucial Literature: The Science You Need to Know

Study Suggests Peer Support Is Effective for Surgeons Experiencing Distress from Adverse Events

El Hechi MW, Bohnen JD, Westfal M, et al. Design and impact of a novel surgery-specific second victim peer support program. J Am Coll Surg. 2020;230(6):926-933.

El Hechi and colleagues provide valuable data and perspective on the development of a peer support program to assist surgeons suffering from emotional and psychologic distress because of an adverse patient care event. They noted that serious complications occur in 16 percent of inpatient surgical procedures and that death or permanent disability occurs in nearly 1 percent of these cases. Surgeons often feel responsible for the adverse event, but many surgeons hesitate to seek help for the anxiety, loneliness, and depression that may result. The authors describe the development and implementation of a one-to-one peer support program. Although 19 percent of surgeons who were offered support chose to opt out of the support program, approximately 80 percent of those surgeons who chose to participate felt that the program was safe, timely, and led to psychological improvement. The authors noted that the study was limited because of its implementation in a single health care institution, and only 67 percent of the program participants provided evaluations.

Ongoing Clinical Trials Focus on COVID-19 Pandemic

Bauchner H, Fontanarosa PB. Randomized clinical trials and COVID-19: Managing expectations. JAMA. 2020.

Starr P. Using controlled trials to resolve key unknowns about policy during the COVID-19 pandemic. JAMA. 2020.

The COVID-19 pandemic has begun to produce a large amount of published data on the clinical presentations of the disease, its epidemiology, and potential means of treatment or prevention. Bauchner and Fontanarosa note that more than 1,000 COVID-19-related studies are registered on ClinicalTrials.gov, 600 of which are studies of treatments. An understanding of important characteristics of randomized clinical trials will help surgeons make the best use of the data and provide optimal care and helpful patient counseling. The authors emphasize that many ongoing studies lack a true control group, and many were started before information emerged to improve our understanding of the disease process. They further emphasize that few of the current trials have mortality as a major outcome variable because they are insufficiently powered to provide dependable data on this variable. Most of the trials address treatment and not prevention. Because the trials are being conducted in various countries around the world, there is a significant risk that adequate sharing of data will not occur. The authors emphasized that accurate reporting of results and presentation of independent interpretations of the published studies will be critical to a complete understanding of the implications for successful prevention, treatment, and future funding of research.

Starr’s opinion piece discusses the conduct of controlled trials of social interventions, such as alternative housing for quarantining at-risk individuals and determining the effects of reopening schools. The fact that many potentially infected patients cannot take advantage of alternative housing suggests an opportunity for comparative studies of alternately housed versus non-housed patients that could provide important data. Given that many political leaders would like to reopen schools, an opportunity to conduct potentially valuable research is a possibility. Starr cites an example that Norwegian investigators have proposed, wherein students return to school in three two-week cycles, with increasing proportions of returning students in each cycle. This model would allow a sequence of disease transmission studies that might improve our understanding of transmission and potentially prevent exposure of a significant proportion of students to infection.

Additional Readings

The Lancet, Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study

JAMA, Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: A randomized clinical trial