LAUSR

Editor We thank Pellino and Pellino for their interest in our short systematic review on the impact of patient death on surgeons1. The point raised about surgeons as a risk variable for postoperative outcomes and surgical errors is of interest. In fact, this topic was not developed in our systematic review, as the aim was to assess the reactions of surgeons when facing patient death, irrespective of cause. It is true that the second victim phenomenon shares similarities with surgeon reactions to patient death. However, response to this neglected problem is likely insufficient due to lack of support. The concept of the second victim2 is a vast, interesting and rarely reported topic in surgery, and might be an interesting theme for another paper focusing on surgeons. If an error occurs due to a preventable decision or act on the part of the surgeon, it can often have harmful consequences for the future behaviour of that surgeon. To protect themselves from the increasing potential of judicial sanctions in today’s society, surgeons might be tempted to practise defensive medicine, with unnecessary examinations to validate therapeutic