Complications in Neurosurgery: Ethics, Morals and Legalities

Complication is a secondary disease or condition aggravating an already-existing one. It is an unfortunate part of surgery that makes consequences worse than those of the original disease. Every medical field has complications, but those in neurosurgery can be truly devastating. There are two sides of the coin of complications: (1) anticipation/prevention and (2) recognition/management. “Prevention is better than cure.” Ensuring the safety/well-being of the patient is more important than eliminating the disease itself. The WHO Surgical Safety Checklist is one of the recommended controls that is widely followed and modified to suit individual circumstances for the prevention of complications. Ethics pertains to moral principles that govern a person’s behaviour or professional conduct. They hold a special place in our practice of medicine and aim to minimise complications. In medical practice, mistakes are not allowed and seldom forgiven. Among medical disciplines where legal claims award a payment to the plaintiff, neurosurgery tops the list (Jena et al., 2011, NEJM). Moreover, 88% of physicians were likely to be sued by age 45, 99% by age 65. Among known medical errors (MEs) the top four are postoperative infection, device failure, failed back syndrome and operative haemorrhage. However, one must differentiate between MEs and complications. General principles for minimising legal action are to make the patient and family your allies. Address allegations promptly, honestly and professionally. Issues like negligence, malpractice, adverse events and never events need to be defined and understood. Open disclosure and other corrective measures, implemented after a complication occurs, help mitigate litigation. Apart from the first victim, the unfortunate patient, the second victim is the surgeon. The surgeon’s plight is no less and needs succour. Don’t forget: “It is easier to stay out of complications than get out of complications.”