The Courage to Share: Dr. Paul Kurlansky on the Importance of Publishing Adverse Surgical Outcomes

Heart surgeons doing an operation in the OR

A study you co-authored was recently shared on X (Twitter) by a heart surgeon who said, “What a great article on adverse events in aortic root surgery. So refreshing to see a surgical group honestly reporting negative experiences, which we can all learn from and improve on. Bravo.”

It struck me as a unique opportunity to dive a little bit deeper into that statement and explore the significance of this research presented by the Division of Cardiothoracic Surgery and published in the latest issue of The Annals of Thoracic Surgery:

Adverse Technical Events During Aortic Root Replacement

Authors: Megan Chung MD, Kavya Rajesh BS, Yu Hohri MD, PhD, Yanling Zhao MS, Chunhui Wang MD, MPH, Christine Chan CCP, Yuji Kaku MD, Koji Takeda MD, PhD, Isaac George MD, Michael Argenziano MD, Craig Smith MD, Paul Kurlansky MD, Hiroo Takayama MD, PhD

Can you talk a little about why publishing a study like this is so important?

I had the pleasure and honor of working with Dr. Takayama on many of his research projects. When he decided to pursue this study, I advised him that the editors would either love or hate him for it. You see, surgeons don’t typically publish these kinds of results. I really congratulate him for his courage. The classic paradigm in surgery is, "We did X many cases, had great results," or "Our technique is superior." It's rare for a surgical team to come forward and say, "We ran into these problems." But it's incredibly important.

It seems like the study breaks from tradition by sharing real-world challenges. Were there any precedents for this kind of transparency?

There was actually an old company called Cope that used to hold a yearly conference, completely off-the-grid. Surgeons would present their worst disasters, and the other attendees would respond by sharing their own bad outcomes. It was informal, with no publications or societal oversight, but it was a candid space for people to learn from mistakes. However, public disclosure of negative outcomes is rare, even today. This study and the editorial comment by master surgeon Tirone David, which followed it, provided invaluable insights for other surgeons. It addressed mistakes to watch for during this type of surgery—critical information that you don’t often see in print.

Surgeons are human, and mistakes happen. With that said, how can the profession protect patients from surgical errors?

You’re right. Surgeons are human, and we learned a lot from the airline industry’s approach to safety. In the 1970s and 80s, there were landmark aviation disasters, and it became clear that one person’s mistake could lead to tragedy if no one questioned the decision. That culture changed when the airline industry adopted protocols that encouraged anyone who noticed something wrong to speak up. It’s similar in surgery: if one person makes a mistake, the whole team has the responsibility to catch it. That's why awareness and empowerment within the surgical team are essential to prevent errors from impacting patient outcomes.

Do you think publishing adverse outcomes can change how surgical teams approach challenges in the operating room?

Absolutely. There’s a long-standing tradition in academic surgery called Morbidity and Mortality Conferences, where we discuss behind closed doors the bad things that happen, especially mortalities. It’s an educational space. The point is not to accuse or blame, but to learn from each case. What can be applied to future situations? The more aware you are of possible complications, the better prepared you’ll be. But part of the challenge is that these events are rare. It’s hard to keep rare events top of mind when they don’t happen frequently.

Looking at the data, was there anything that surprised you?

Not really. In fact, it was reassuring that some of the adverse events were as rare as they were. Maybe I’m jaded, but there weren’t any shocking revelations. It’s important to share these occurrences, though, because putting them in proportion helps people understand the risks.

How might this data be valuable to other institutions?

Publishing this data allows other institutions to look at their own complication rates and compare them. It creates a learning opportunity. That said, for a patient, this information would be difficult to interpret. The numbers might be reassuring in terms of low percentages, but the concept of "adverse technical events" may sound alarming. It's different from complications, which are often patient-related events. Adverse technical events are more about surgical mishaps.

In terms of training, how could reviewing adverse events data help young surgeons?

It’s crucial for training. They don’t call it the "practice" of medicine for nothing. Surgery, especially cardiac surgery, is incredibly humbling. You can be the most experienced surgeon, but occasionally things just don’t go well. I’ve seen even the best surgeons face adverse events. Part of training is learning how to cope when things go sideways, and it’s something you develop over time. Reviewing adverse event data would give trainees insight into the unexpected challenges that may arise and prepare them to react quickly.

As a final takeaway, what do you think is the most important message from publishing studies like this one?

Transparency is key. We need to celebrate our successes, but we must also recognize and learn from our failures. It’s only through this kind of transparency that we can truly improve as a profession.

 

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