Improving outcomes in spinal surgery patients

Abstract

Improving outcomes in spinal surgery patients Padmaja Durga invasiveness of the procedure and the presence of other comorbidities, which may be part of the spinal disease. Assessment also varies depending on whether the surgery is elective or emergent. A complete medical evaluation includes basic historical information such as medical problems, surgeries, current medications, allergies, substance use and prior issues with anaesthesia or surgery. Of particular importance is identifying pre-operative medical conditions that increase the risk of surgery and anaesthesia for the patient. These conditions include heart disease, diabetes, chronic obstructive pulmonary disease and bleeding dyscrasias. Pre-operative optimisation of cardiac, pulmonary, renal and nutritional status has been correlated with improved outcomes in surgical patients overall. [1] Identification of these medical risks can then be weighed against the type and duration of surgery including number of levels, estimated blood loss and expected post-operative course. Careful physical examination can also yield important information regarding positioning during surgery and airway issues. In particular, surgical approaches to the cervical spine often require meticulous attention to positioning and can make intubation more challenging particularly in the setting of instability. Flexion and extension manoeuvres can be performed while the patient is awake to assess for evidence of neurologic symptoms. In particular, patients with severe arthritis or complex trauma with instability may have limited neck and jaw mobility necessitating fibre optic intubation. Knowledge of these circumstances before surgery promotes safety and efficiency in the operating room. Positioning-related complications Spinal surgery is associated with complex morbidities when there is inattention to proper positioning technique. Problems arising from malpositioning of the patient undergoing spinal surgery are attributed to Pre-anaesthetic evaluation Avoiding complications in spine surgery begins with careful patient selection and pre-operative evaluation. Pre-anaesthetic assessment varies depending on the approach required, the pathology involved, the