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.