The Surgeon’s Emotional and Physical Sequelae After Intraoperative Surgical Complications: A Systematic Review and Meta-Analysis Suggesting a Distinct Phenomenon,Surgical Complication Adverse Reaction Syndrome (SCARS)

Abstract

Background:

Intraoperative surgical complications (IOSCs) are common in surgical practice and can trigger sometimes severe psychological distress in surgeons.

Purpose:

We sought to define the symptomatology that follows IOSCs and identify surgeons’ coping mechanisms to expose gaps in institutional support and guide future improvements.

Methods:

We conducted a systematic search of Ovid, Embase, and PubMed from database inception through March 30, 2025, using terms related to IOSCs, “second victim” phenomena, and adverse events. The protocol was registered in PROSPERO (ID CRD420251107191). Inclusion criteria were (1) studies involving licensed surgeons or surgical trainees (residents or fellows); (2) participants having had direct experience of an IOSC, adverse surgical event, or medical error; (3) studies assessing psychological or physical symptoms experienced by the surgeon in response to the event; (4) studies providing primary quantitative or qualitative data; and (5) publications in English or English translation. Studies were excluded if they did not directly address surgeon impact, focused on litigation or technical outcomes, or were not tied to a specific intraoperative complication. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies and the JBI Critical Appraisal Checklist for Qualitative Research assessed the risk of bias in accordance with study design. Results were synthesized by extracting proportions from each study, converting to absolute numbers, and calculating pooled proportions across studies that reported each outcome.

Results:

A total of 14 studies were included in this review; 2315 surgeons participated in these surveys and self-response questionnaires. Surgeons reported guilt (65%), insomnia (40%), anger (32%), anxiety (28%), and depression (13%). To address their symptoms, most surgeons relied on peers (52%) or had no support (37%). Only 7% accessed formal help.

Conclusion:

This systematic review and meta-analysis of survey and questionnaire studies found that many surgeons reported experiencing psychological and physical symptoms in response to IOSCs. Because these responses are common, underrecognized, undertreated, and unique to surgeons, we propose that these post-IOSC physical and psychological sequelae and subsequent performance impairment be termed “surgical complication adverse reaction syndrome,” and that structured interventions are needed.

Level of Evidence:

Level IV: systematic review and meta-analysis of level-IV studies.