O2133: Navigating the Fallout: How Pediatric Spine Surgeons Cope, Recover, and Persevere After Major Surgical Complications

Background: Complications in pediatric spine surgery have significant emotional, ethical, and legal consequences. However, little is known about the factors that differentiate surgeons who continue performing spine surgery from those who transition away. We hypothesized that surgeons who continue practicing after a major complication are more likely to have strong institutional and peer support, a growth mindset, and access to coping mechanisms that mitigate distress and legal pressures.

Methods: Thirty-three pediatric spine surgeons who had experienced a major surgical complication were interviewed using Constructivist Grounded Theory (CGT) semi-structured interviews. Of these, 28 continued practicing spine surgery, while 5 transitioned away. Participants described their most career-defining complication (modified Clavien-Dindo-Sink grade 4 or 5) and its impact on their career trajectory and well-being. Thematic analysis identified key patterns in support systems, ethics , emotional burden, resilience, and institutional trust.

Results: Surgeons had an average of 22 years in practice (range: 2–38). 2 were female. Complications occurred at a mean of 12 years into practice (range: 1–32). 12 had experienced a patient death, 15 encountered an intraoperative and 10 a delayed spinal cord injury. 15 complications were due to a surgical error and 9 surgeons faced a lawsuit.
Five major themes emerged:
1. Support Systems – Institutional and peer support were critical; lack of support correlated with distress and career attrition.
2. Ethical Responsibility – Surgeons expressed deep accountability; full disclosure helped mitigate emotional and legal repercussions.
3. Emotional Impact – Guilt, shame, fear, and regret were most common. Those who reframed complications as learning experiences were more likely to continue practicing.
4. Legal and Risk Management – Litigation and fear of legal action exacerbated distress, leading some to alter decision-making.
5. Resilience and Professional Growth – Surgeons who continued practicing exhibited greater emotional resilience, mentorship networks, and commitment to patient safety.

Conclusion: Surgical complications are transformative events in a surgeon’s career. Institutional support, mentorship, and structured coping mechanisms are key determinants of whether a surgeon recovers, adapts, and continues performing pediatric spine surgery. These findings underscore the need for peer support systems, ethical transparency, and mental health resources to enhance surgeon well-being and career sustainability.