Neurosurgical focus · 2026
An international perspective on grief in neurosurgery: a survey study on how neurosurgeons deal with complications.
СтатьяНазвание и аннотация: Перевод в очереди
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El-Hajj Victor Gabriel, Piper Keenan, Roy Joanna, Musmar Basel, El-Hajj Carina, Magdamo Brigid, Turqui Castillo Alexandra, Atallah Elias, Williamson Theresa, Gooch M Reid, Tjoumakaris Stavropoula, Rosenwasser Robert H, Gandía-González María Luisa, Elmi-Terander Adrian, Evans James, Staartjes Victor E, Jabbour Pascal
Аннотация
OBJECTIVE: Complications in neurosurgery are virtually inevitable due to the specialty's high-stakes nature. The emotional impact of these events on neurosurgeons is profound, yet little is known about how surgeons cope across different healthcare and cultural systems. Understanding these coping mechanisms is critical to support well-being and reduce burnout. Hence, the authors aimed to characterize the emotional and behavioral responses of neurosurgeons to complications and to examine differences in coping strategies between practitioners in Europe and the US.
METHODS: The authors conducted an international, cross-sectional survey of practicing neurosurgeons and neurosurgery residents. The survey assessed baseline characteristics, experiences with complications, emotional impact, coping behaviors (adaptive and maladaptive), psychological defense mechanisms, and effects on clinical practice and professional confidence.
RESULTS: A total of 256 respondents (114 Europe, 142 US) completed the survey. Complications were almost universally experienced. Emotional impact was substantial, with 99% reporting at least minimal immediate distress and 98% having persistent long-term effects. Adaptive coping strategies, such as taking complications as teaching opportunities (81%), discussing with partners (64%) or mentors (52%), and engaging in physical activity (57%), were common, whereas maladaptive behaviors, including sleep disturbances (55%), social withdrawal (33%), and procrastination (29%), were also prevalent. Similarly, mature psychological defenses, including humor (57%), affiliation (54%), altruism (50%), suppression (45%), and sublimation (25%), were frequently used, although negative defenses such as intellectualization (70%), rationalization (41%), and isolation (38%) remained common. Some regional differences were observed. US neurosurgeons were more frequently implicated in litigation and were more likely to utilize faith, mindfulness, and therapy (p < 0.05). They also reported utilizing mature defense mechanisms humor, affiliation, and sublimation more commonly than European counterparts (p < 0.05). European neurosurgeons were more likely to question their clinical abilities and less likely to admit fault to the patient every time (p < 0.05). Complications influenced professional confidence (72%) and caused practice modifications in a substantial share of surgeons both short term (43%) and long term (20%).
CONCLUSIONS: Complications in neurosurgery are unavoidable and associated with substantial emotional burden. Surgeons use a spectrum of coping behaviors and defense mechanisms, with adaptive strategies and mature defenses supporting resilience and professional growth. The principle of "forgive and remember" provides a constructive framework: self-forgiveness facilitates moving forward, while remembering and learning from complications supports professional development and improved patient care.
METHODS: The authors conducted an international, cross-sectional survey of practicing neurosurgeons and neurosurgery residents. The survey assessed baseline characteristics, experiences with complications, emotional impact, coping behaviors (adaptive and maladaptive), psychological defense mechanisms, and effects on clinical practice and professional confidence.
RESULTS: A total of 256 respondents (114 Europe, 142 US) completed the survey. Complications were almost universally experienced. Emotional impact was substantial, with 99% reporting at least minimal immediate distress and 98% having persistent long-term effects. Adaptive coping strategies, such as taking complications as teaching opportunities (81%), discussing with partners (64%) or mentors (52%), and engaging in physical activity (57%), were common, whereas maladaptive behaviors, including sleep disturbances (55%), social withdrawal (33%), and procrastination (29%), were also prevalent. Similarly, mature psychological defenses, including humor (57%), affiliation (54%), altruism (50%), suppression (45%), and sublimation (25%), were frequently used, although negative defenses such as intellectualization (70%), rationalization (41%), and isolation (38%) remained common. Some regional differences were observed. US neurosurgeons were more frequently implicated in litigation and were more likely to utilize faith, mindfulness, and therapy (p < 0.05). They also reported utilizing mature defense mechanisms humor, affiliation, and sublimation more commonly than European counterparts (p < 0.05). European neurosurgeons were more likely to question their clinical abilities and less likely to admit fault to the patient every time (p < 0.05). Complications influenced professional confidence (72%) and caused practice modifications in a substantial share of surgeons both short term (43%) and long term (20%).
CONCLUSIONS: Complications in neurosurgery are unavoidable and associated with substantial emotional burden. Surgeons use a spectrum of coping behaviors and defense mechanisms, with adaptive strategies and mature defenses supporting resilience and professional growth. The principle of "forgive and remember" provides a constructive framework: self-forgiveness facilitates moving forward, while remembering and learning from complications supports professional development and improved patient care.