Surgeons Are Not Pilots: Is the Aviation Safety Paradigm Relevant to Modern Surgical Practice?

Error in surgery is common, although not always consequential. Surgical outcomes are often compared to safety data from commercial aviation. This industry's performance is frequently referenced as an example of high-reliability that should be reproduced in clinical practice. Consequently, the aviation-surgery analogy forms the conceptual framework for much patient safety research, advocating for the translation of aviation safety tools to the healthcare setting. Nevertheless, overuse or incorrect application of this paradigm can be misleading and may result in ineffective quality improvement interventions. This article discusses the validity and relevance of the aviation-surgery comparison, providing the necessary context to improve its application at the bedside. It addresses technical and human factors training, as well as more novel performance domains such as professional culture and optimization of operators' condition. These are used to determine whether the aviation-surgery analogy is a valuable source of cross-professional learning or simply another safety cliché.

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Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors report no conflict of interest with respect to this publication. Dr Mamode and Dr Sevdalis have no direct conflict of interests to declare with regards to this publication, but would like to acknowledge the following funding and collaborations: Prof Mamode reports funding for advisory boards and speakers’ expenses from Hansa, Novartis and Alexion. Unrestricted research funding has been received from Shire and Behring, outside the remit of this paper. Prof Sevdalis reports being the director of the London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organizations. Dr Sevdalis also reports grants from the National Institute of Health Research (NIHR) Applied Research Collaboration, grants from King's Improvement Science, grants from Guy's and St. Thomas’ Charity, grants from the Maudsley Charity, grants from the ASPIRES research programme, grants from the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, outside the submitted work. Nick Sevdalis is also the director of the London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organizations.