Professional Grief and the Second Victim Experience in Neurosurgery: An International Cross-sectional Study on Professional Sustainability and Educational Implications.

OBJECTIVE: Adverse events are inevitable in neurosurgical practice and may have significant emotional and professional implications for surgeons. While second victim experiences have been increasingly recognized, the role of professional grief remains insufficiently characterized within the field of neurosurgery. This study aimed to examine professional grief as a component of the second victim experience and its associations with distress, support dimensions, educational needs, and professional sustainability. METHODS: We conducted an international, cross-sectional, anonymous web-based survey among neurosurgeons and neurosurgical trainees. Professional grief related to a personally impactful adverse event was assessed retrospectively using the Professional Bereavement Scale-Short-term Bereavement Reactions Subscale (PBS-Acute); scores therefore reflect retrospectively recalled acute grief responses rather than contemporaneously measured reactions. Second victim dimensions were evaluated with the Second Victim Experience and Support Tool-Revised (SVEST-R). Associations among grief severity, second victim dimensions, and professional sustainability indicators were analyzed using correlation and multivariable regression. RESULTS: Of 465 respondents from 49 countries, 314 completed the survey and were included in the analysis. A total of 240 participants (76.4%) reported a personally impactful adverse event. Professional grief severity was substantial among respondents (PBS-Acute mean 37.9 ± 13.8) and was strongly correlated with psychological distress (ρ = 0.71, p < 0.001). Higher grief severity was independently associated with increased turnover intention (β = 0.026, p < 0.001). Perceived preventability and primary surgeon role were associated with higher grief severity, while event timing and seniority were not. Supervisor support was inversely associated with grief severity. Participants reported substantial unmet educational needs related to medicolegal processes, communication with patient families, and grief coping skills. CONCLUSIONS: Among surveyed neurosurgeons who described a personally impactful adverse event, professional grief was frequently reported. Professional grief in this sample was associated with second victim experiences, psychological distress, and indicators of professional vulnerability. These cross-sectional associations suggest that professional grief may warrant consideration in structured educational models and tiered support systems within neurosurgical training and institutional practice. Prospective work is needed to clarify the direction and durability of these relationships and their implications for professional sustainability.