“If you really want to mess things up, pick the wrong patient and the wrong surgeon”


Ciaran Bolger, Department of Neurosurgery, Beaumont Clinic, Dublin, Ireland, discussed the causes of complications following spinal surgery at the Brussels International Spine Symposium (9–10 November, Brussels, Belgium). In order to avoid or minimise the risk of complications, he emphasised on the need to choose the “right patient”, the “right operation”, the “right surgeon” and the need to choose adequate technology.   

Bolger mentioned the medical and economic consequences perceived after complications in spinal surgery occur, he told delegates: “It is worth remembering that one single complication that we give to our patients, on average, increases the length of hospital stay by four days; it increases the mortality 20-fold; and the cost increase, on average—even if it is a small complication—is about US$10,000, so there is an economic impact to what we do all.”

“We can describe poor outcome as failure to improve satisfactorily after spinal surgery. Some of the easy things we do are decompressions for people’s backs, but the ones that fail are unable to return to work, or require ongoing analgesics. In lumbar discectomy, long term pain relief is reported to fail in eight to 25% of patients,” noted Bolger.

He stated that choosing the wrong patient to operate on was one reason why complications occur. Therefore, he said, it is important—prior to intervention—to review a patient’s symptoms, biological factors, co-morbidities, and other conditions (psychological or medical). “We often forget the psychological factors and the impact of the outcomes for the patients, we all talk about it and we all know about it, but very few people actually measure it before they operate on patients,” he said.

He added that it was also important to ensure that the patient has received adequate conservative treatment. He commented: “It is important to check if the patients have had a period of avoiding heel impact sports, prolonged sitting, prolonged standing and heavy manual work.”

Another reason for complications, Bolger explained, was the “wrong surgeon”—ie, the surgeon makes a mistake or does the wrong procedure is used. He said: “If you really want to mess things up, pick the wrong patient and the wrong surgeon.” However, Bolger added that you could have the “right patient, the right surgeon but the wrong technology, if you use the wrong technology, again disasters happen.”

“No matter how fancy our tools are, how impressive our computers systems are, we have to keep checking that we are doing the right thing with the technology we have,” said Bolger. 

Concluding, he said, to minimise the risk of complications, surgeons should: “Try to pick the right patient, try to pick the right operation, and try to be a good surgeon. If all else fails, blame the technology.”