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Welcome - a message from our Chief Executive

If you think things are changing fast today, here is my story from the most exciting times in modern medicine: it is a two-minute read.

Average length of stay (ALOS) from 19 to 4.6 days!

The question, the answer, the lesson.

How was it possible that the average length of stay on the patient ward at the Department of

Neurosurgery in Oulu, Finland, dropped dramatically from 19 days, when the service started in 1975 as Finland's second comprehensive service for all the specialty needs of a catchment region, to 4.6 days when I retired from my clinical position in 2010?

I can answer for the period 1994-2010 when I was the Head of the service, facilitating in every way possible what I call the transition from the era of classical neurosurgery to the present age of minimally invasive neurosurgery. Together with researchers, we pioneered intraoperative ultrasound imaging, neuronavigation and intraoperative MRI.

My colleagues also quickly adopted intravascular techniques such as coiling (instead of clips) since 1993, neuromodulation (instead of lesions) for Parkinson's disease and other movement disorders since 1996, microsurgery for lumbar and cervical degenerative disease (today enabling same day surgery) since 1991, and so on.

Importantly: None of these methods were available when I started my neurosurgical training in 1978!

In my service these developments were possible due to a stable department with experienced colleagues, among whom I was youngest, all of us determined to provide the best possible care for our patients. The idea: let's improve our methods first in order to avoid the need for prioritizing.

Technology, especially when actually developing it from scratch, costs a lot of money. Immensely more has been saved due to better outcomes, quicker recovery times, and dramatically shortened lengths of hospital stay. Today, we would choke on rising patient needs without modern treatment methods.

That is why I chose a research career in surgical technology and why at regular intervals I spent a lot of time at the Department of Neurosurgery, University of Minnesota, situated in the postwar world cradle of medical technology, a stimulating environment where I had been raised.

Any neurosurgeon of my restless generation can cite similar shortening of lengths of hospital stay in his or her service. But there is a lesson here for the next generation.

If neurosurgeons themselves do not invent, develop and/or implement ever better new methods, who will? If you lead such research groups, learn as I did from the original Bell Laboratories, as you also have a relationship with an important no-nonsense entity: Your hospital, and your patients.

And for those of you who can fund this type of worthwhile research, please do! You may benefit from it someday.


Department of Neurosurgery, University of Oulu, and Oulu University Hospital, Finland

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