Responding to Surgical Errors: From Psychological Impact to Disclosure-A Systematic Review

Transparent management and disclosure of surgical errors and adverse events (AE) are essential for patient safety and staff well-being. This systematic review synthesizes evidence on how surgical errors and AE are experienced and disclosed, focusing on their psychological impact on clinicians, coping strategies, support resources, and barriers to disclosure.

A systematic search of PubMed, PsycINFO, CINAHL, and WoS Core Collection was conducted without date restrictions, using also additional sources and automatic alerts. Two reviewers independently screened studies, assessed quality, and extracted data. Findings were synthesized narratively.

A total of 30 studies involving 11,723 participants were included. Surgical staff reported significant emotional distress following AE, with guilt (53-89%) and anxiety (45-88%) commonly reported and up to 96% experiencing some emotional impact. Coping strategies varied, while formal psychological support was rarely (1.6-7%) accessed. Reporting and disclosure practices were inconsistent, with disclosure rates ranging from 17 to 62%. Major barriers included fear of litigation, unclear institutional procedures, and hierarchical pressures. Although disclosure was widely recognized as ethically correct, individual and systemic obstacles persisted. Training interventions improved communication skills, but gaps remained.

This systematic review highlights the substantial psychological impact of surgical errors and AE on clinicians, underscoring the need for organizational strategies that protect staff well-being. Evidence directly addressing psychological factors involved in disclosure remains limited. Clearer disclosure protocols, enhanced communication training, and accessible psychological support may reduce distress among surgical staff and promote transparent, patient-centered error management, particularly in complex surgical fields such as oncological care.