Available online 10 January 2013
Publication year: 2013
Source:World Neurosurgery
Objective Since the mid-1950s, neurosurgery has benefited from remarkable progresses created by tremendous advances in neuroimaging techniques, neuroanaesthesia, neurostimulation and brain-computer interfaces, as well as breakthroughs in operating microscopes and surgical instruments. Yet, this speciality has to do with delicate human structures, and is hence considered as highly risky by insurance companies. In France, although neurosurgery's casualty rate (6%) is lower than in other specialities, the number of legal prosecutions has increased since 2002 due to easier access to medicolegal procedures. In order to avoid patients resorting to the law courts, it becomes necessary to clearly identify the risk factors. Methods From the data bank of the SHAM insurer (main insurance company for public hospitals in France), we retrospectively analysed 115 files (34 cranial, 81 spinal surgeries) for the reasons for complaints against French neurosurgeons working in public hospitals covering the period from 1997 to 2007. Results Five main causes were identified: surgical site infection (37%), technical error (22%), lack of information (14%), delayed diagnosis (11%) and lack of supervision (9%). Conclusion Some causes are definitely avoidable at no cost to the hospital. Besides basic preventive safety procedures, we reiterate the mandatory steps for a good defence when being prosecuted. The evolution of patients' attitudes towards medical institutions observed in most countries has forced surgeons to adapt their practice. In this context, a common action certified by learned societies on sustainable healthcare quality, patient safety, respect of good practices, appears as the golden path to maintain a favourable legal, insurance and financial environment.
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