Coping strategies of neurosurgeons in response to major surgical complications: A nationwide questionnaire assessment in Germany.

Abstract

Introduction: This study aimed to explore the emotional and psychological impact of major surgical complications on neurosurgeons in Germany, focusing on identifying coping strategies, perceived barriers to support, and the influence of institutional culture - particularly in the context of the "second victim" phenomenon.

Research question: How do neurosurgeons in Germany handle major complications, and which barriers limit access to psychological support?

Material and methods: In this cross-sectional study, a nationwide, anonymous online survey was conducted among neurosurgeons working at university departments across Germany. The survey included 18 items assessing demographics, exposure to high-risk procedures, emotional responses to Clavien-Dindo Grade IV/V complications, coping mechanisms, and access to institutional support. Data from 110 completed questionnaires were analyzed using descriptive statistics.

Results: Eighty percent of participants reported experiencing a major complication, with 60% still being emotionally affected. High levels of guilt and self-doubt were common. The most frequent coping strategies were proactive behavior (62.4%), rumination (57.8%) and seeking social support (60.6%). Only 26.4% reported to have had access to formal psychological support - although 82.7% of those without access considered it necessary. Maladaptive coping was more prevalent in low-tolerance error cultures, and early-career surgeons were more likely to externalize blame.

Discussion and conclusion: Major complications considerably impact neurosurgeons' mental health. Yet, institutional support remains insufficient. The findings call for mandatory, confidential psychological support, structured debriefings, and a cultural shift toward non-punitive, learning-oriented environments, supported by medical ethics, as a key instrument of cultural change to safeguard both surgeons' well-being and patient safety.