{
  "abstract": "Background Complications not only affect patients but also impose a significant psychological burden on physicians. Quantitative data in neurointerventional surgery regarding the ‘second victim’ phenomenon are lacking. This study aimed to assess the prevalence and severity of post-traumatic stress symptoms among neurointerventionalists after major complications.Methods A survey was developed by a committee of experienced neurointerventionalists and distributed internationally via multiple platforms. Respondents were anonymous. Demographic information, complication type, and institutional support availability were queried. Psychological distress was measured using the validated Impact of Event Scale-Revised (IES-R), which assesses intrusion, avoidance, and hyperarousal domains. Descriptive statistics and regression analyses were performed to identify factors associated with post-traumatic stress symptoms.Results Of 1042 invited physicians, 503 responded (48%), with 413 completing the full survey (40%). The most common pathology was cerebral aneurysm, and the most frequent complication was hemorrhage. Overall, 64% scored above the IES-R threshold for possible post-traumatic stress disorder (PTSD) (≥24), with many reaching levels (≥37) associated with long-term stress and physiological sequelae. Intrusion was the dominant symptom domain, particularly distressing reminders about the complication. Lack of institutional support was significantly associated with possible PTSD (OR 1.63, 95% CI 1.1 to 2.5, P=0.02). No differences were observed by specialty, but geographic variations were present. High stress scores persisted long after the index event.Conclusion Complications exert a profound emotional and physiological toll on neurointerventionalists, with high rates of possible PTSD and a strong association with inadequate institutional support. Systematic support programs are urgently needed to safeguard physician well-being and patient safety.",
  "authors": [
    {
      "affiliations": [
        "Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA"
      ],
      "name": "Ansaar T Rai"
    },
    {
      "affiliations": [
        "Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"
      ],
      "name": "Emanuele Orru"
    },
    {
      "affiliations": [
        "Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA"
      ],
      "name": "Kyle M Fargen"
    },
    {
      "affiliations": [
        "Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"
      ],
      "name": "Fabian Arnberg Sandor"
    },
    {
      "affiliations": [
        "Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA"
      ],
      "name": "Ricardo A Hanel"
    },
    {
      "affiliations": [
        "Radiology, Ochsner Medical System, New Orleans, Louisiana, USA"
      ],
      "name": "James M Milburn"
    },
    {
      "affiliations": [
        "Neurology, Boston University School of Medicine, Boston, Massachusetts, USA"
      ],
      "name": "Thanh N Nguyen"
    },
    {
      "affiliations": [
        "Neurointerventional Surgery, Interventional Neuro Associates, University City, Missouri, USA",
        "Neurology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA"
      ],
      "name": "Nathan Farkas"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA",
        "Neurointerventional & Neuroanalytics Collaboration, Toronto Metropolitan University, Toronto, Ontario, Canada"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Adnan H Siddiqui"
    }
  ],
  "title": "Unseen wounds: a multinational investigation of neurointerventionalists on the psychological toll of complications",
  "uid": "f38f8f21-c16a-59c5-9217-f77a8a4e4db1"
}