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Background and aim <p>Morbidity and Mortality (M&amp;M) conferences are the bedrock of neurosurgical quality improvement, yet they often prioritize “audit culture” over surgeon well-being. Despite the high-stakes nature of the specialty, little is known about how these meetings influence the “Second Victim” phenomenon. This study aimed to systematically define current neurosurgical M&amp;M structural practices and synthesize cross-specialty evidence to identify ‘structural-emotional mismatches’ between quality improvement design and surgeon well-being.</p> Methods <p>A systematic literature review was conducted following PRISMA 2020 guidelines. We searched four databases (Web of Science, Medline via PubMed, Scopus, Embase) from inception to December 15, 2025. The review included neurosurgical studies analyzing M&amp;M structure and efficacy, alongside cross-specialty literature examining the psychological impact of adverse events and “blame culture.” Study quality was assessed using the MINORS index.</p> Results <p>Ten neurosurgical studies met the inclusion criteria. Neurosurgical literature focused predominantly on error taxonomy and surveillance. Thematic synthesis identified four structural deficits contributing to psychological harm: the “Silence Gap” (exclusion of high-trauma events), the “Taxonomy Trap” (prioritizing naming over processing), “Culpability Focus” (reinforcing blame), and “Ritual Fatigue” (lack of perceived efficacy).</p> Conclusion <p>Current neurosurgical M&amp;M models emphasize accountability at the expense of psychological safety. Cross-specialty analysis confirmed that traditional M&amp;M formats often exacerbate shame and isolation, failing to provide rituals for grief processing.The focus on “avoidability” and categorization fosters a culture of blame that may fuel professional burnout and hinder recovery from the Second Victim syndrome. Reforming M&amp;M to integrate restorative justice and emotional support is essential for sustainable practice.</p>

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Morbidity and mortality conferences in neurosurgery: a systematic review of current practice and narrative synthesis of the second victim phenomenon

  • 期刊论文

  • 发表日期：

    2026年6月19日

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  • Omar Alomari,
  • Beyzanur Güney,
  • Deniz Kiliç,
  • Onder Ertem,
  • Mert Korkmak,
  • Akin Akakin,
  • Murat Şakir Ekşi,
  • Türker Kiliç

摘要

Background and aim

Morbidity and Mortality (M&M) conferences are the bedrock of neurosurgical quality improvement, yet they often prioritize “audit culture” over surgeon well-being. Despite the high-stakes nature of the specialty, little is known about how these meetings influence the “Second Victim” phenomenon. This study aimed to systematically define current neurosurgical M&M structural practices and synthesize cross-specialty evidence to identify ‘structural-emotional mismatches’ between quality improvement design and surgeon well-being.

Methods

A systematic literature review was conducted following PRISMA 2020 guidelines. We searched four databases (Web of Science, Medline via PubMed, Scopus, Embase) from inception to December 15, 2025. The review included neurosurgical studies analyzing M&M structure and efficacy, alongside cross-specialty literature examining the psychological impact of adverse events and “blame culture.” Study quality was assessed using the MINORS index.

Results

Ten neurosurgical studies met the inclusion criteria. Neurosurgical literature focused predominantly on error taxonomy and surveillance. Thematic synthesis identified four structural deficits contributing to psychological harm: the “Silence Gap” (exclusion of high-trauma events), the “Taxonomy Trap” (prioritizing naming over processing), “Culpability Focus” (reinforcing blame), and “Ritual Fatigue” (lack of perceived efficacy).

Conclusion

Current neurosurgical M&M models emphasize accountability at the expense of psychological safety. Cross-specialty analysis confirmed that traditional M&M formats often exacerbate shame and isolation, failing to provide rituals for grief processing.The focus on “avoidability” and categorization fosters a culture of blame that may fuel professional burnout and hinder recovery from the Second Victim syndrome. Reforming M&M to integrate restorative justice and emotional support is essential for sustainable practice.