The Naked Neurosurgeon and the Anatomy of a Complication

IntroductionThe neurosurgeon is always poised precariously between the operation and the abyss of a complication. As Wilder Penfield sagaciously wrote in 1961, "I will faithfully record and analyze my failures in the care of the sick, seeking the cause, so that those who follow may be warned of the danger."AimThis paper seeks to briefly overview the literature on complications in surgery, neurosurgery in particular.Materials and MethodProgress in our specialty has been accomplished by the overcoming of complications via technique or technology. Dr. Samer Nashef commented sarcastically that surgeons are not, as a general rule, well known for their rapacious appetite for reading. But knowing the literature on complications from our field and others is essential for progress. We must know the anatomy of complications to avoid and manage them.In 1992, Michael Apuzzo published his magnus opus, Brain surgery: Complication avoidance and management, which was admirably followed by Edward Benzel's edited work Spine surgery: Techniques, complication avoidance and management, setting standards in the science of complication avoidance and management in 1999 for years to come. In 2001, Crossing the quality chasm: A new health system for the twenty-first century was published in the United States by the Institute of Medicine. Lucian Leape (a pediatric and thoracic surgeon) published Error in Medicine in JAMA in December 1994, and in 1991, he published the Harvard Medical Practice Study, defining essential terms like adverse event and negligence. Atul Gawande, a general surgeon at Harvard University, wrote "The Bell Curve: What happens when patients find out how good their doctors really are," in the New Yorker on December 6, 2004; he went on to pen Complications-A surgeon's notes on an imperfect science in 2002 and Better: A surgeon's notes on performance in 2007; and he peaked with his classic The Checklist Manifesto-How to get things right in 2009. In 2015, The Naked Surgeon-The power and peril of transparency in medicine appeared. Written by a cardiothoracic surgeon, Samer Nashef, the book takes the study of complication avoidance to a different level and describes how cardiac surgery blazed the trail in quality monitoring and improvement, leaving no scope for other specialties but to follow. The era of the naked neurosurgeon may be beginning anytime.ConclusionEver since E. C. Pearce delivered the 34th Rovenstine lecture, 40 years behind the mask-Safety revisited, in 1996, the literature on complication avoidance and management has been growing exponentially. Cross-specialty discourse and the exchange of ideas are essential for neurosurgery to maintain its position as the emperor of all specialties.