Second victim syndrome in surgeons: systematic review and meta-analysis of the impact of adverse events on surgeons

TL;DR

This study reviews how adverse events affect surgeons' mental health, finding common symptoms like anxiety and guilt, and suggests support strategies to help them cope.

Contribution

The study provides a comprehensive meta-analysis of SVS in surgeons, identifying key symptoms and coping strategies with statistical prevalence rates.

Findings

Anxiety, guilt, sadness, and sleep disturbance are the most common symptoms of SVS in surgeons.

Talking to colleagues or family/friends are the most frequently used coping strategies.

Surgeon sex, experience level, and event severity are potential predictors of SVS impact.

Abstract

Second victim syndrome (SVS) is characterized by negative psychological and psychosomatic effects on a healthcare provider after an adverse care event. The aim of this systematic review and meta-analysis was to characterize the symptoms of SVS experienced by surgeons and factors affecting their impact, as well as understand common coping strategies that surgeons employ to deal with them.

A systematic review of five electronic databases was conducted without restrictions on publication date or language in January 2025. Second victim syndrome, surgeon, and adverse event and their synonyms were used as search terms. Records were screened, quality assessed, and data extracted by two independent researchers. Both qualitative and quantitative studies were included and narratively synthesized. A meta-analysis was performed using a random effects model to calculate the overall prevalence rates of symptoms and coping methods.

A total of 36 papers were included in the analysis from 6629 retrieved records. Anxiety (56.3% (95% c.i. 45.8% to 66.3%)), guilt (53.8% (95% c.i. 41.3% to 65.8%)), sadness (48.3% (95% c.i. 34.6% to 62.3%)), and sleep disturbance (50.5% (95% c.i. 38.4% to 62.5%)) were the most commonly reported symptoms. Talking to either colleagues (72.5% (95% c.i. 65.6% to 78.4%)) or family/friends (52.0% (95% c.i. 40.6% to 63.2%)) were the most commonly employed coping strategies. The sex and level of experience of the surgeon and the severity of the event were identified as potential predictors of deleterious impact.

SVS significantly impacts surgeons’ global well-being, leading to burnout and attrition. Effective interventions require a multifaceted approach, including peer support, resilience training, and institutional changes that normalize emotional responses, encourage disclosure, and address barriers to seeking help. Targeted support for at-risk groups may also be necessary.

This systematic review and meta-analysis found that adverse events or complications in surgical practice significantly impact the surgeon. Common symptoms are anxiety, guilt, sadness, and sleep disturbance. The currently available research highlights the need for multifaceted interventions, such as peer support and resilience training, to address second victim syndrome and prevent burnout among surgeons.

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