“Hey we are bleeding!”

Through my extensive research on complications and how they impact on the lives of surgeons, I am familiar with the anguish, anxiety and self-doubt that complication events cause surgeons every day. However, we don’t talk openly about our complications and failures, nor the feelings of inadequacy they cause, because we don’t want to be seen as incompetent. At the same time, not acknowledging those feelings and not talking about failure, will leave us none the wiser and worsen feelings of guilt and shame.

This is part of the reason why I started SurgicalPerformance. I felt that some of my patients endured severe complications. Some of those were rare and unexpected, and that uncertainty, unpredictability and the human cost of it, caused me stress. Then I realised that I didn’t even know exactly how many of those procedures I had done over the last year or two, let alone know what my complication rate was; and more importantly, how my complication rates compared to colleagues doing the same procedure. I still remember the feeling when I saw the first prototype of SurgicalPerformance waiting in my inbox, and then the excitement of experimenting with it, knowing it would help me know better. I could enter data and saw that this data was available to me immediately in real-time thanks to, what was then, modern technology.

That was 12 years ago, and since then SurgicalPerformance has improved markedly, advancing as technology advanced. What it is today is so much better than what was so excitingly valuable to me back then.

The following story, that one of our SurgicalPerformance customers told me, beautifully demonstrates the value I was excited about back then. It is specifically her story, but I will share it as it could happen to all of us.

Our colleague saw a young patient with a large uterine fibroid for consideration of a myomectomy. The surgeon has done many of those previously. In fact, she gets patients referred by its colleagues with fibroids larger than 5 cm. Our doctor is very familiar with minimally invasive surgery because she trained in a specialist program where she was mentored by a very capable and supportive senior colleague.

Preoperatively, the patient had an MRI and it appeared that the fibroid was pedunculated and connected to the uterus through a small vascular stalk. While the fibroid appeared larger at laparoscopy than anticipated, the surgeon was still able to visualise the stalk, sealed it and divided it with very limited bleeding.

However, the fibroid resisted being mobilised out of its original position. After placing additional ports, the surgeon realised that it was adherent to the peritoneum of the upper abdomen, which was an area that the surgeon did not visualise until then. Repeated attempts to mobilise the fibroid from its adhesions resulted in brisk bleeding.

What was planned to be a seemingly straight forward procedure turned into a very stressful time. With every minute the fibroid could not be detached from its adhesions, the intraoperative blood loss increased, like a ticking clock.

A decision was made to convert the laparoscopic procedure to a laparotomy that opened the upper abdomen. Finally, the fibroid was detached from its adhesions, the feeding blood vessels were secured and the surgeon secured haemostasis. The blood loss exceeded 2 litres. The patient required a blood transfusion, but recovered well otherwise.

According to SurgicalPerformance, which captures hundreds of myomectomy cases in Australia and New Zealand, the average blood loss for a laparoscopic/robotic myomectomy procedures is between 230 and 260 ml, but two thirds of patients experience blood loss of up to 600 ml.

Our surgeon expected an intraoperative blood loss of 20 ml and actually experienced a blood loss in excess of 2000 ml.

We all get bad outcomes sometimes. And unfortunately, we remember the cases that go awfully wrong… vividly. The ones that go well get often forgotten.

SurgicalPerformance helps surgeons like you and me keep our outcomes in perspective. The bad ones and the good ones. We need to count them all.

SurgicalPerformance helps me get over bad complications when they happen. Rather than letting bad complications dominate my thoughts, SurgicalPerformance tames these events (and also my thoughts) by giving them a place and putting them in a place. Bad occurrences are rare and SurgicalPerformance allows me to see them as a rare.

By approaching this from a rational perspective, I am then able to reflect on my case and what I could have done different and better to avoid a bad outcome in the next problematic situation.

Rationally and emotionally, the big value in SurgicalPerformance is in how it helps us (in so many ways now) to ‘know better’; to ‘be better’ surgeons with a higher proportion of excellent outcomes, and to ‘cope better’ personally as human beings when on rare occasion, things don’t go as hoped. Because human is what we all are.