Death on the table: how do operating room staff experience intraoperative deaths? : A narrative synthesis of qualitative evidence

Background: Intraoperative deaths, though statistically rare, may evoke varied emotions among operating room (OR) staff that remain underrecognized and inadequately addressed. Aim: To synthesise and summarise the qualitative evidence regarding experiences of surgeons, anaesthetists, and nurses following patient death in the OR. A secondary aim is to unpack strategies to support OR staff following an intraoperative death experience. Design: Narrative review of qualitative studies. Data sources: Peer-reviewed databases (PubMed, EMBASE, CINAHL, Web of Science, Scopus, and Cochrane Review Library) and grey literature sources (such as thesis databases) were extensively searched for peer-reviewed primary studies and non-peer-reviewed literature respectively reporting on intraoperative deaths or deaths occurring in the OR. Results: Five qualitative studies were retained. The synthesis revealed that unexpected OR deaths or those deaths perceived as sudden or preventable evoked more severe and enduring psychological repercussions, marked by guilt, hypervigilance, emotional and moral distress. In contrast, anticipated fatalities, particularly in patients with advanced illness evoked less intense emotions, but not eliminating emotional tolls. The findings revealed divergent coping mechanisms among OR professionals: surgeons often engaged in meaning-making or employed emotion- and problem-focused strategies to process loss. In contrast, anaesthetists described emotional desensitization over time. Nurses, meanwhile, navigated a pervasive culture of silence. Conclusion: The emotional toll captured in this paper underscores urgent needs for interventions, such as team-based debriefing support, alongside systemic reforms to normalize vulnerability and integrate emotional stewardship into institutional policies. Addressing this is not only ethically imperative but critical to sustaining a resilient workforce and ensuring patient safety in an era of escalating surgical demand.