Review Article

Incidence and Factors Associated with Burnout in Anesthesiology: A Systematic Review

Table 2

Studies included in the systematic search on burnout in anesthesia. For each study, we quote in the second column the population investigated, the response rate, the questionnaire used for assessment of burnout, and the country where the survey was performed. Burnout prevalence is indicated either overall or according to subscales, as reported by the author. In the last column, we report the criteria adopted by each study in order to define the risk of burnout. EE: emotional exhaustion; DP: depersonalization; and PA: personal achievements. MBI: Maslach Burnout Inventory. UBOS: Utrechtse Burnout Schaal.

StudyPopulation
Response rate
Burnout questionnaire used
Country/region
Burnout Subscales scores Criteria for burnout classification

Kluger et al.
Anaesthesia
2003
Anesthesiologists
422/700 (60%)
Full MBI (22q: EE 9, DP 5, PA 8)
Australia
-EE high 20%; moderate-high 43%
DP high 20%; moderate-high 47%
PA low 37%; moderate-low 63%
Burnout was defined as EE (>27) combined with DP > 10 and/or PA < 40. Moderate risk of burnout not reported

Nyssen et al.
Brit J Anaesth
2003
Anesthesiologists & anesthesia residents
151/318 (48%)
MBI (only EE 9q)
Belgium (French speaking)
-EE high 40%; moderate-high 84%High risk (severe) of burnout if EE > 29, moderate risk if EE = 18–29.
Used a Likert scale 1–7 rather than 0–6

Morais et al.
Eur J Anaesthesiol
2006
Anesthesiologists
270/850 (31%)
Full MBI (22q: EE 9, DP 5, PA 8)
Portugal
-EE high 58%
DP high 91%
PA low 45%
EE: high risk if >26
DP: high risk if >14
PA: high risk if <24

Prins et al.
Int J Behav Med
2007
Residents, multiple disciplines (13/29 anesthesia)
158/292 (54%)
UBOS-MBI (20q,8 EE,5 DP,7 PA)
Netherlands (Groningen)
High 4%
Moderate 9% (overall);
Anesthesia 0%
-High risk (severe) of burnout if >28 on EE + >10 on DP; or if >28 on EE and <24 on PA

Capuzzo et al.
Anesth Analg
2007
43 anesthesiologists & 68 anesthesia nurses (79%)
Full MBI (22q– n/r EE, DP, PA)
Italy (4 centers, Tuscany)
High 27%-High risk of burnout if EE > 26 and DP > 9 and/or PA < 34

Chiron et al.
J Health Psycol
2010
74 anesthesiologists & 77 anesthesia nurses (78% overall)
Full MBI (22q: EE 9, DP 5, PA 8)
France (8 centers, n/r)
-EE high 16%; moderate-high 38%
DP high 18%; moderate-high 41%
PA low 13%; moderate-low 46%
EE: high risk if >29, moderate risk if 18–29
DP: high risk if >11, moderate risk if 6–11
PA: high risk if <34, moderate risk if 34–39

De Oliveira et al.
J Clin Anesth
2011
Anesthesia program directors 100/132 (76%)
Short MBI (12q: EE 5, DP 3, PA 4)
US
High 20%
Mod.-high 30%
Moderate 22%
-Scores calculated as proportional values of the full MBI. EE: high risk if >26; DP: high risk if >9; PA: high risk if <32. High risk of burnout if high EE and DP and low PA. Moderate risk criteria n/r

De Oliveira Jr. et al.
Anestheisology
2011
Chairs of academic anesthesia Dept. 102/117 (79%)
Short MBI (12q: EE 5, DP 3, PA 4)
US
High 28%
Mod.-high 31%
Moderate 11%
-Scores proportional to the full MBI. EE: high risk if >26; DP: high risk if >12; PA: high risk if <32. High risk of burnout if high EE and DP and low PA. Moderate risk if at least 2/3 met

Downey et al.
Anaesthesia
2012
Anesthesiologists, anesthesia residents, and fellows
57/61 (93%)
Full MBI (22q: EE 9, DP 5, PA 8)
US (Boston)
-EE high 30%; moderate-high 61%
DP high 10%; moderate-high 32%
PA low 65%; moderate-low 93%
EE: high risk if >26, moderate risk if 17–26
DP: high risk if >12, moderate risk if 7–12
PA: high risk if <32, moderate risk if 32–38

De Oliveira Jr. et al.
Anaesth Analg
2013
Anesthesia residents
1508/2773 (54%)
Short MBI (12q: EE 5, DP 3, PA 4)
US
High 41%-Scores calculated as proportional values of the full MBI
EE: high risk if >26, moderate risk if 17–26
DP: high risk if >12, moderate risk if 7–12
PA: high risk if <32, moderate risk if 32–38
High risk if moderate or high score in at least 2/3 of subscales

Orena et al.
Saudi J Anaesth
2013
12 anesthesiologists & 6 anesthesia nurses (78% overall)
Full MBI (22q – n/r EE, DP, PA)
Italy (Milan)
-EE high 22%; moderate-high 39%
DP high 22%; moderate-high 44%
PA low 17%; moderate-low 33%
EE: high risk if >23, moderate risk if 15–23
DP: high risk if >8, moderate risk if 4–8
PA: high risk if <30, moderate risk if 30–36

Shams and El-Masry
Sultan Qaboos Univ Med J
2013
Academic anesthesiologists, anesthesia residents
98/134 (73%)
Full MBI (22q – n/r EE, DP, PA)
Egypt (Mansoura)
-EE high 62%
DP high 56%
PA low 58%
Not clearly reported

Magalhães et al.
Rev Bras Anestesiol
2015
Anesthesiologists (12% in leading position)
134/241 (56%)
Full MBI (22q: EE 9, DP 5, PA 8)
Brazil (Federal District)
High 10%
Low 8%
EE high 23%; moderate-high 54%
DP high 28%; moderate-high 77%
PA low 48%; moderate-low 86%
EE: high risk if >25, moderate risk if 16–25
DP: high risk if >8, moderate risk if 3–8
PA: high risk if <34, moderate risk if 34–39

Van der Wal et al.
Eur J Anaesthesiol
2016
Anesthesia residents and anesthesiologists of Dutch Society
655/1955 (33%)
UBOS-MBI (20q:EE 8, DP 5, PA 7)
Netherlands
High 18%-High scores defined as above 75th percentile of the UBOS-MBI manual

Rui et al.
J Eval Clin Pract
2016
Anesthesiologists, residents, and specialty doctors
395/416 (95%)
Full MBI (22q: EE 9, DP 5, PA 8)
China
EE high 15%; moderate-high 40%
DP high 8%; moderate-high 25%
PA low 35%; moderate-low 66%
EE: high risk if >26, moderate risk if 16–26
DP: high risk if >12, moderate risk if 6–12
PA: high risk if <32, moderate risk if 32–39
High EE (≥27), high DP (≥13), and low PA (≤39) scores indicated high degrees of burnout