Practice of medicine has been the most gratifying experience of our lives as much as it is life-transforming for our patients. Yet, despite its amazing preventive and therapeutic achievements, it’s not free of complications, sometimes making the treatment worse than the disease. Though encountered in all fields of medicine, Complications in Neurosurgery can be truly devastating. Having participated in conferences over 4 decades I realised that most presentations harped on the success of techniques and skills, with scant mention of their pitfalls, complications and adverse events. I realised that though success gives one satisfaction, especially when tackling a complex case, there is little learning otherwise; on the other hand, encountering mishaps or catastrophes left a deep scar that would never be forgotten. True learning came from such disasters, and it does not spare any surgeon, irrespective of his / her experience, nor depended on the complexity of the disease, ironically, often occurring with so-called ‘minor’ cases which one tended to take on too lightly and without adequate planning. So, it became clear that everyone of us had faced minor or major complications on several occasions during our career, but very little was documented, discussed or even reflected upon, even while inflicting severe morbidity or even mortality on our patients. Were we shy, embarrassed or just not too seriously bothered? Whatever be it, we are ethically and morally answerable to our patients and sometimes (even) legally punishable. It would therefore be wiser to learn from complications, both of our own making as well as of others.
With that concept we announced our intent to hold the first International Conference on Complications in Neurosurgery – ICCN, in March 2017. It aroused great curiosity and interest among neurosurgeons worldwide as it was the first time an entire 3-day conference was dedicated to discuss Complications in Neurosurgery. The ground rule was that the Complication(s) ought to have been directly experienced by the presenter or a member of his / her team, and contents of the conference would not be exposed to the social media. The presentations were grouped in sessions concerning a region or sub-speciality of our field and controlled by panelists or moderators who would discuss and cross-examine why the complication occurred and was not anticipated or prevented, and lessons learnt. The first 2 days of this 3-day conclave were devoted to brain problems and the last day to the Spine. Owing to the overwhelming response (about 80 papers per day) most presentations were restricted to 3 - 5 minutes. In the process discussion time was limited and we tried to correct that in the subsequent conferences. We also had couple of speakers each day to talk on ethical, moral and legal aspects of Complications. The value and success of this conference was realised all over in the world as a breakthrough in the field of medical conferencing, and the President of WFNS initiated a new Committee on Complications in Neurosurgery as a unique educational initiative.
A board was constituted by inviting committee members from across the world and pledged to hold this meeting once every 2 years. But in order to keep the concept serve its purpose of documenting complications and learning from them and from each other all the year round, we contemplated on creating a NeuroComplications web-based platform that would serve as a ‘Repository’ of all Complications, submitted by any member who registers on that platform, and also as a means to stage regular virtual meetings. It was a kind of premonition, as, when the pandemic struck, prohibiting international travels, the platform was ready to serve through our monthly webinars in NeuroComplications which continue till date, thanks to the interest exhibited by colleagues worldwide. Selected papers of this 1st ICCN were edited and published as a supplement of Acta Neurochirurgica by Springer.
The 2nd ICCN was held with great expectation and enthusiasm in Jan 2019, and was physically attended by over 500 delegates from 50 countries. Then came the pandemic, but by then we already had been hosting regular webinars, and used the opportunity by holding a spectacular virtual 3rd ICCN using the most modern technology, where, on the platform we had virtual registration desk, Conference Hall, Chat rooms, Industry stalls and one-on-one interaction among delegates. This 3rd ICCN was held from 5th – 7th March 2021, carefully planned to cover maximum times zones, and permitting those unable to participate in certain regions, to go on our platform in retrospect (which they can do even today 24 x 7 as all physical conferences and virtual webinar presentations will remain available for posterity).
The 3rd ICCN secured the distinction of being attended over 38 hours, spread over 3 days, by a staggering 12,890 delegates worldwide from 90 countries, and by Who’s Who, of the World of Neurosurgery.
ICCN has secured its firm footing in Neurosurgical education and we are now on the threshold of its 4th meeting to be held 10 – 12 March 2023, once again in Mumbai, India. Learning from our past experiences, we have tweaked the format by highlighting a specific Complication at a time, with presenters, discussing its occurrence in a given case-setting or a series of cases and emphasising on its avoidance, complication, prevention; their management and outcome, and again lessons learnt! Since this, is a face-to-face meeting, we will rejoice with handshakes and hugs and direct discussion on a vast array of issues that were kept in our closets during the pandemic. As usual this will be an open forum of interactive brainstorming but strictly within closed doors.
We urge neurosurgeons, seniormost to residents, from all corners of the world, to join us and have a free, frank and fearless discussion of various Complications encountered during their career. We welcome you to this one and only International Conference in the world that deals entirely and exclusively with Complications in Neurosurgery -- their Avoidance and Management.
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 4th 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,
OC, O Ont, MD, PhD, FRCSC
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 â€œothersâ€� and I hospitals such as â€œSt Elswhereâ€�.
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 patientsâ€™ wellbeing: one can read papers where surgeons review their own retrospective series, and evaluate considerable morbidity and mortality as â€œacceptableâ€�.Click here to continue reading
Editor in chief, Acta Neurochirurgica
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 reading
MD, 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.
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.
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.
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.
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.
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.
I am great full for your kind invitation and hospitality. I appreciate your kind thought of providing me a platform in your esteemed workshhop.
"One complication leads to another - The Domino Effect. It may often not be the last."