Do Surgical Setbacks Shape Surgical Judgment? Exploring the Psychological and Cognitive Effects of Complications on Neurosurgeons: A Cross-Sectional Study from Pakistan.

BACKGROUND

Neurosurgery carries one of the highest complication-associated morbidity burdens of any surgical specialty. While patient-facing consequences of adverse events are well documented, the psychological, professional, and financial impact on the operating neurosurgeon, the "second victim," remains poorly characterized, limiting the development of evidence-based support frameworks.

OBJECTIVE

To examine the psychological and behavioral sequelae experienced by neurosurgeons following major surgical complications and to identify unmet institutional support needs.

METHODS

A cross-sectional anonymous online survey was distributed to neurosurgeons across varied practice settings and career stages across Pakistan. Domains included complication exposure, emotional impact, confidence changes, decision-making modifications, morbidity and mortality conference participation, support received, financial consequences, medicolegal concern, and preferred support modalities. Descriptive statistics were applied.

RESULTS

Eighty-one neurosurgeons participated. Major complications were reported by 96%; neurological deficit and postoperative infection were most common, 62% each. More than 63% rated emotional impact at 4 or 5 of 5, and 73% reported a postcomplication decline in surgical confidence. Fear or hesitation in managing similar cases affected 72%. 86% modified their decision-making through increased conservatism, defensive documentation, and greater second-opinion seeking yet 77.8% received no formal support. Financial consequences affected 27.2% and 75.3% perceived inadequate institutional financial protection.

CONCLUSIONS

Surgical complications impose a substantial multidimensional burden on neurosurgeons, encompassing emotional distress, confidence erosion, and financial strain. The near-universal absence of formal support represents a critical institutional gap. Structured peer support, reflective debriefing, and financial protection mechanisms should be systematically integrated into neurosurgical practice.