How Do Neurosurgeons Cope With Complications? Results of a Nationwide Survey

BACKGROUND AND OBJECTIVES: Complications are an unfortunate but ubiquitous part of neurosurgery, affecting both patient outcomes and surgeons' well-being. No study exists which has defined the impact that these complications have on neurosurgeons' emotional well-being or sought to define the various ways they choose to cope with them. METHODS: We surveyed 142 members of the Congress of Neurological Surgeons about the impact that complications have on them. RESULTS: Most respondents had complications that resulted in the death of a patient (58.4%) and even more had complications that resulted in short-term or long-term harm (80.3% and 79.6%, respectively). Complications had a significant (55.6%) or profound (38.0%) impact on emotional well-being. The most common defense mechanisms used were humor (64.1%) and intellectualization (68.3%). On subgroup analysis, junior neurosurgeons were more likely to use a greater number of both adaptive and maladaptive coping mechanisms than were senior neurosurgeons (parameter estimate [standard error] = −0.31 [0.14], P = .02 and parameter estimate [standard error] = −0.37 [0.14], P = .01, respectively). Academic neurosurgeons were more likely to question their clinical abilities than were private (OR 2.68, 95% CI 1.21-5.96). Neurosurgeons with maladaptive coping mechanisms were 5.84 times more likely to consider leaving the profession (95% CI 2.34-1.60) and 3.08 times more likely to limit their practice in the short term (95% CI 1.35-6.99). When assessing years of practice, type of practice, or sex, there was no difference in contemplation of leaving the field, self-doubt, propensity to admit fault, or number and type of coping mechanisms. CONCLUSION: Complications have a major impact on the well-being of neurosurgeons, who use a variety of mechanisms to cope with them. Neurosurgeons with maladaptive coping mechanisms are more likely to question their career choice, consider leaving the field, and modify their practice after experiencing a complication.