Surgeons’ Stress Assessment after Surgical Mortality: First International Validated Survey (Stressurg Study)

BACKGROUND: Unexpected perioperative death is one of the most distressing events in surgical practice and may lead to burnout or post-traumatic stress symptoms, with potential implications for surgeon well-being and patient safety. However, its psychological impact remains insufficiently quantified. AIM: The STRESSURG study assessed the prevalence and severity of post-traumatic stress symptoms among surgeons after unexpected surgical deaths and explored associated professional, demographic, and institutional factors. METHODS: An international, cross-sectional online survey endorsed by the IHPBA and ESCP was distributed to surgeons who experienced intraoperative or early postoperative (< = 48 h) patient death. The 42 - item questionnaire included demographics, professional data, and the validated Impact of Event Scale-Revised (IES-R). RESULTS: A total of 354 surgeons participated. Median IES-R score was 22.5 (IQR, 14-35). Clinically relevant distress (≥ 24) was observed in 48.6%, probable PTSD (≥ 33) in 29.1%, and severe distress (≥ 37) in 24.6%. Distress was higher among intermediate-career surgeons and when acting as primary surgeon. Only 8% received institutional psychological support, although over half believed it should be mandatory. CONCLUSIONS: Unexpected surgical deaths impose a substantial psychological burden on surgeons, driven largely by operative responsibility. Structured institutional support is urgently needed.