Intraoperative Catastrophes in Neurosurgery: Can Situational Awareness Make the Difference? Results of an International Survey

Introduction: Neurosurgery is a field prone to significant intraoperative adverse events that contribute to increased morbidity, mortality, and healthcare costs. While conventional training emphasizes surgical skills, cognitive factors such as situational awareness (SA) are often overlooked. SA training, which has proven effective in fields like aviation and emergency medicine, may offer substantial benefits in enhancing the quality of neurosurgical care. This study aims to assess neurosurgeons' perceptions of SA and its potential role in improving patient care.

Methods: A cross-sectional survey was conducted from 1/11/2022 to 30/03/2023, collecting responses from 76 practising neurosurgeons worldwide. The questionnaire explored their intraoperative experiences, familiarity with SA, and training in managing unexpected complications. Statistical analysis was performed using R programming via JASP statistical software.

Results: A significant majority (72.3%) of neurosurgeons reported encountering catastrophic intraoperative events such as unexpected bleeding and brain swelling at least once annually. Approximately 84.5% of these events resulted in fatalities, with 84% of respondents believing that they could have been prevented. Moreover, 64.5% suggested that improving workflows and disaster readiness systems could reduce the incidence of these complications. Despite 71.4% being familiar with the concept of SA, only 1.6% demonstrated a clear understanding of it. There was a moderate correlation between structured cognitive skills training and the ability to manage unexpected events (p = 0.006). Neurosurgeons in academic practice were 20 times more likely to be familiar with SA compared to those in private practice (p = 0.003). Additionally, 85% of respondents strongly supported the incorporation of SA training into neurosurgical residency programs.

Conclusion : Neurosurgeons frequently face preventable catastrophic intraoperative complications, underscoring the importance of cognitive skills like SA in improving patient outcomes. There is a significant gap in SA training within neurosurgical education. Integrating SA training into neurosurgical curricula may enhance preparedness, reduce complications, and improve overall patient safety.