Complications are an inherent part of our practice of medicine, especially with surgical specialities. Neurosurgery is the most intricate of all, and complications in this field can be truly devastating, and may not only make the patient and his/her family miserable but also tarnish the name of the neurosurgeon and the specialty at large. There are two sides of the coin of Complications – Anticipation or Prevention, and Recognition and Management. In our increasingly litigious society, it is best to make every effort to prevent them from occurring by careful attention to patient’s history and clinical examination (before jumping to the images), accurate reading of scans and other investigations, and discussing the nuances of the case, preparing detailed plan and alternatives towards its approach, execution and closure (or repair), with members of the neurosurgical and allied specialty teams. Involving the patient and his/her family in decision-making, making them allies of our plan and patient-care will lessen the ill-feeling and agitation that can possibly arise following a complication. Intra-op management of complication is often complex, and if well-planned, intra-op adverse events can be handled swiftly, and with least fuss or agony between the surgeon and his team; but in the face of unexpected events, much will depend upon the experience and wisdom of the surgeon. Again, it is necessary and prudent to convey such events to the patient’s family as soon as one can.
The issue of dealing with Complications in Neurosurgery is vast, and opinions diverse and even paradoxical. Social, cultural, geographical and economic factors also come into play. Hence, it is essential to discuss such cases and events in an open forum, unabashedly, with a view to learning from each other, and as an obligation to our patients. Such a forum can help us share and lighten the huge burden we carry, create consensus and even act as insulation from criticism or penal action by the authorities.
With this, and many such issues in mind, we had organised the 1st International Conference on Complications in Neurosurgery (ICCN) in Mumbai, India in March, 2017. This was attended by 383 delegates from 25 countries. All 215 presentations were deliberated over 3 days (average 72/day) in one ballroom hall so that no one missed out any discussion. The response at that meeting and its spinoffs were truly encouraging. Suddenly there is a buzz all around with many local and regional conferences devoting a session or two to discussing Complications, with some basing the theme of an entire conference on it. The President of WFNS pronounced a new Committee on this important issue under my Chairmanship, and we are now poised to host the 2nd ICCN, again in Mumbai, 25th thru 27th January, 2019.
Whilst the basic format remains the same as of 1st ICCN, we will minimise didactic lectures and provide more time for discussion. The details of scientific program will be spelt out in the appropriate section. We invite all members of our large neurosurgical community from all corners of the world to meet under one roof and partake of this unique educational event.
Dear Keki,
Congratulations to you on the organization of the 2nd International Conference on Complications in Neurosurgery. As Neurosurgeons, it is most important that we remember our challenging cases, and complications that may arise. We all will have our complications as neurosurgeons throughout the world. The important point is how we manage these complications. Typically, it is the review and analysis of our complications which lead to tremendous improvement in our specialty.
For all these reasons, it is critically important that meetings such as 2nd ICCN continue to be held. I am sorry I cannot be with you at this time. However, I wish you all the success possible in your meeting, and I look forward to reading about its proceedings in due course.
With best wishes,
Sincerely
OC, O Ont, MD, PhD, FRCSC
FRSC,FACS, FAANS
Dear Keki,
It is already time for the Second International Conference on Complications in Neurosurgery. The first conference was successful, ant the occurrence of these conferences mark a breakthrough in Neurosurgery. Hitherto, complications have been an elephant in the room which have been accomplished to occur in the hands of “others� and I hospitals such as “St Elswhere�.
This means that neurosurgical careers have been forged in denial of untoward outcomes and complications; it has been common to view complications as signs of insufficient professional abilities and subsequently difficult to admit and handle personal complications. Naturally, insufficient knowledge and deficient professional ethics can lie behind complications and neglect of complications can reflect disregard for patients’ wellbeing: one can read papers where surgeons review their own retrospective series, and evaluate considerable morbidity and mortality as “acceptable�.
Click here to continue readingEditor in chief, Acta Neurochirurgica
FRSC,FACS, FAANS
INITIAL TRAINING IN NEUROSURGERY AND RISK MANAGEMENT
The training of a surgeon should no longer be limited to the theoretical and practical teaching of the treatment of diseases of the specialty, with the main focus being the surgical procedure (1). Taking into account the quality and safety of care is imperative. In addition to the decision-making capacity, the information given to patients as well as the risk management must be a new priority and must be integrated into the initial training.
The worldwide literature (1) on patient safety reveals the importance of medical risks in hospital structures with 350 000 to 460 000 serious events per year in France, of which 120 000 to 190 000 can be considered as available (2). Data on 1,777,035 patients for the years 2006-2011 were acquired from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as "neurological surgery." Over 38,000 neurosurgical cases were analyzed, with complications occurring in 14.3% (3)
Click here to continue readingMD, MSc Health Economy, Professor of Neurosurgery
Expert, High Authority of Health (Paris), Education Committee, World Federation of Neurosurgical Societies
My Dear Keki
Thank you for the superb and unique meeting you organized in Mumbai. Your choice was fabulous since we rarely spend sufficient time on complications and errors in our practice. I enjoy the discussions and controversies concerning special cases especially because the majority of speaker play an honest role talking on what they have have done wrongly and what they were supposed to do.
Thank you for that and thank you for the incredible organization of your meeting. The social program was great and I was impressed by the show and the female singer.
Kind regards my dear friend for your kind invitation.
Dr Keki,
Before leaving India, I would like to thank you - formally - again very much for your great thoughts and efforts with which you and your team made this fascinating congress possible. I learned a lot from all lectures and the discussions, and it would be great pleasure for me if we would edit a possible book together, if you wish.
All the best - relax and enjoy - and do keep a good work-life balance!
Dear Prof. Keki Turel,
Thank you for inviting me to this wonderful conference. And congratulations on your success. The content was so educational as to greatly impress myself. I will continue to brush up my skills while truthfully taking care of the patient.
Looking forward to seeing you next.
Respectfully Yours.
Dear Keki
Thank you very much for everything in Mumbai.
Your congress was so wonderful, and very philosophical.
I could study a lot.
I hope to see you again. Thank you very much.
Dear Keki
It was a wonderful meeting which I never experienced before. Complication is the mother of improvement of skill and knowledges. This kind meet will greatly impact YNS and senior NS both.
Once again thank you for your hospitality and give us a chance.
Dear Dr Keki
Thank you very much for your hospitality.
The meeting was so impressive for me discussing about complications. Your passion and will, led us to such a successful meeting.
I could not meet you for saying my appreciation and good-bye at the final day.
Thank you very much.
Thank you very much.
Dear Sir
My hat-off salute to you and your team on successful completion of such an extraordinary meeting on Neurosurgery.
I feel proud to be part of the meet.
Dear Dr Turel,
Thanks for the opportunity to present at the meeting. It is truly a unique event. I learnt a lot in the time I was there.
Hope you conduct this annually.
Regards
Respected Sir
Heartiest congratulations for organizing a successful conferece... It was throughly enjoying, educational and has provided room for more thought and introspection.
Thank you for providing an opportunity to reflect within and participate in the scientific proceedings.
Warm Regards
Respected Sir
I am great full for your kind invitation and hospitality. I appreciate your kind thought of providing me a platform in your esteemed workshhop.
Thanking You
"One complication leads to another - The Domino Effect. It may often not be the last."