Neurosurgery 98:752–764, 2026
This study reports results of a nationwide survey assessing how neurosurgeons emotionally respond to surgical complications and which coping and defense mechanisms they use. It quantifies prevalence of patient harm, emotional impact, common adaptive and maladaptive behaviors, and associations with career effects such as limiting practice or contemplating leaving neurosurgery.
Findings show frequent use of intellectualization, humor, and affiliation alongside maladaptive behaviors that strongly predict career doubt and short-term practice changes, with junior surgeons reporting more coping strategies. The authors recommend institutional support, targeted interventions, and further longitudinal research to improve surgeon well-being and patient care.
Prevalence of serious complications Patient harm was commonly experienced: minor harm (87.3%), temporary harm (80.3%), long-term harm (79.6%), and patient death (58.4%).
Emotional impact Complications had a significant (55.6%) or profound (38.0%) immediate emotional impact, with long-term impact significant for 44.4% and profound for 12.7%.
Persistent preoccupation Respondents thought about complications weekly (41.5%) or daily (22.5%).
Common adaptive coping Frequent adaptive strategies included using errors as teaching opportunities (80.3%), speaking with a spouse/significant other (65.5%), exercise (61.9%), speaking with a mentor (51.4%), and speaking with friends (49.3%).
Common maladaptive coping Common maladaptive responses included sleep disturbances (52.8%), social withdrawal (38.0%), overeating (25.4%), procrastination (23.2%), and excessive alcohol consumption (11.3%).
Defense mechanisms used The most common defense mechanisms were intellectualization (68.3%) and humor (64.1), along with affiliation (61.2%) and altruism (53.5%).
Career/practice consequences tied to maladaptive coping Maladaptive coping was associated with higher odds of considering leaving the profession (OR 5.84) and limiting practice in the short term (OR 3.08).
Notable subgroup findings Junior neurosurgeons used more adaptive and maladaptive coping mechanisms than senior neurosurgeons, and academic neurosurgeons were more likely than private practitioners to question their clinical abilities (OR 2.68).
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