Surgeon Perceptions of Failure to Rescue After Surgery.

IMPORTANCE

Failure to rescue (FTR)-death following a potentially manageable complication-has become a key quality indicator. Although clinical and systemic contributors to FTR are well described, how surgeons make sense of these events and how this sense-making shapes communication, escalation, and learning remains underexplored.

OBJECTIVE

To explore surgeon interpretations of FTR events and perceptions of factors that contribute to FTR and to identify insights to inform improvements in surgical education and culture.

DESIGN, SETTING, AND

PARTICIPANTS

Qualitative study using convenience sampling to recruit board-certified surgeons with 5 or more years of experience in Switzerland and Austria via email. Semistructured interviews were conducted between February and May 2023. Data analysis was performed between February 2024 and April 2025.

EXPOSURE: Direct involvement in FTR events.

MAIN OUTCOMES AND MEASURES: Interviews were analyzed using a constructivist grounded theory approach to identify themes characterizing surgeons' perceptions of FTR.

RESULTS

Fourteen surgeons were interviewed, including 12 men (85.7%) aged 33 to 67 years (mean [SD] age, 49 [9] years). Specialties included abdominal surgery (9 surgeons [64.3%]), orthopedics or traumatology (4 surgeons [29%]), and vascular surgery (1 surgeon [7.1%]). Five themes were developed: (1) being trapped in a flawed system: surgeons perceived FTR as inevitable within systemic and institutional constraints; (2) hierarchical barriers: the continued predominance of barriers hinder adequate reaction and shared decision-making; (3) being imperfect heroes: surgeons saw themselves as passionate, resilient, and driven, yet vulnerable to narcissism, peer hostility, and performative behaviors; (4) coping with failure: participants reflected that FTR experiences, though painful, contributed to improving their clinical expertise; and (5) strategies and tools for rescue: these were characterized by sharing personal strategies and proposing system-level improvements.

CONCLUSIONS AND RELEVANCE: In this qualitative study of 14 surgeons, participants described how confidence, grit, and self-reliance were essential in surgery but could also hinder timely recognition and response to complications. Fostering humility, reducing hierarchical barriers, and increasing peer support may transform FTR from a heroic surgeon's hubris into an opportunity for collective learning and cultural growth.