Every spine surgeon eventually encounters an adverse event that stays with them long after the patient has left the hospital, and the profession is beginning to reckon with the psychological toll those moments take, according to an article written by Safdar Khan, MD, and Todd Albert, MD, in the Summer 2026 issue of Vertebral Columns. Dr. Khan is a professor of orthopedic surgery at University of California, Davis, and Dr. Albert is surgeon-in-chief emeritus at Hospital for Special Surgery in New York City.
The piece centers on “second victim syndrome,” a concept first described in 2000 to capture the guilt, shame, anxiety and self-doubt healthcare professionals often experience after an adverse patient event. Those reactions can persist for months or years, the authors wrote, shaping future clinical decisions, professional satisfaction and personal well-being. Most attention in an adverse outcome goes to the patient, the primary victim; far less goes to the surgeon.
Here are three takeaways from the article:
1. Spine surgeons are especially exposed. The authors laid out several reasons for this. The stakes are high, as few specialties can improve or worsen neurological function so dramatically, and even rare complications can cause lifelong disability. Spine surgeons also tend to build deep relationships with patients over months of consultation and follow-up, deepening the personal sense of responsibility when something goes wrong. And a surgical culture that rewards perfectionism can discourage surgeons from acknowledging distress, leaving many to internalize complications and suffer in silence.
2. The fallout reaches patients, too. Unresolved distress may contribute to burnout, compassion fatigue, depression and, in severe cases, symptoms resembling post-traumatic stress disorder, the authors wrote. It can also change how surgeons practice: Some become more defensive, avoid complex cases or hesitate in critical decision-making, while others overcompensate by taking on excessive risk to prove competence. Neither response serves patients, which the authors said makes addressing the syndrome a patient-safety issue, not just a wellness one.
The article singles out morbidity and mortality conferences as a pivotal moment that can help or harm. Historically, some have emphasized individual blame over systems analysis, deepening shame and isolation; modern patient-safety frameworks instead stress root-cause analysis and shared learning, which the authors said better supports surgeons without sacrificing rigor.
3. Peer support is the most effective intervention. Surgeons consistently identify colleagues who understand operative practice as their most valuable source of support after an adverse event, and structured peer-support programs have shown favorable effects on culture and well-being. The authors suggested spine societies and training programs build formal mechanisms, including peer-support networks, confidential debriefing pathways, wellness champions within departments and faculty and resident education on recognizing the syndrome and coping with it.
The authors closed on a reframe: An adverse event is an unavoidable part of a spine surgery career, and the goal is not to eliminate emotional responses but to process them in healthy ways. Many surgeons ultimately describe their most difficult cases as catalysts for growth, greater empathy and quality improvement. Complications may be inevitable, the authors wrote, but suffering alone should not be.
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