The value of preoperative medical assessment for adult spinal deformity surgery: Risk determination, quality, and cost considerations

Arora, Ayush; Wague, Aboubacar; Cummins, Daniel; Berven, Sigurd

doi:10.1016/j.semss.2022.100985

Cited by 1 publication

(12 citation statements)

References 69 publications

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“…In ASD patients, poorly managed insulin and non-insulindependent diabetes are at increased risk for prolonged LOS > 5 days, 30-day readmission, UTIs, and cardiac complications. [3][4][5] Some studies also discuss significantly increased infection risk secondary to poor wound healing in patients with poor diabetic control. 57 When controlled, studies have shown that diabetes does not carry increased perioperative risk compared with ASD patients without diabetes undergoing spine surgery.…”

Section: Diabetesmentioning

confidence: 99%

“…Surgery should be avoided if blood glucose levels are > 400 or the patient is in diabetic ketoacidosis. [3][4][5] Preoperative Hemoglobin and Blood Loss Preoperative anemia can put patients at risk for increased infections, thromboembolisms, and increased length of stay. While intraoperative and postoperative transfusions can be utilized to replenish deficits and further blood loss acquired during surgery, transfusion carries its own risks, such as infection, and increased 30-day readmissions.…”

Section: Diabetesmentioning

confidence: 99%

“…A dult spinal deformity (ASD) can carry challenging operative courses with a high propensity for postoperative complications, ranging anywhere from 10% to 70%. [1][2][3] There have been extensive investigations into the characteristics of deformities that may influence perioperative complication rates and the effect of nonmodifiable risk factors on outcomes. However, modifiable risk factors such as comorbidities (ie, diabetes) and lifestyle habits are crucial in determining a patient's health status and important predictors for postoperative outcomes.…”

mentioning

confidence: 99%

“…However, modifiable risk factors such as comorbidities (ie, diabetes) and lifestyle habits are crucial in determining a patient's health status and important predictors for postoperative outcomes. [1][2][3][4][5] Preoperative optimization provides an opportunity for the surgeon to improve a patient's baseline health and postoperative outcomes. Selective optimization of modifiable risk factors benefits patients by lessening resources and cost burdens on the health care system and allowing for better quality care.…”

mentioning

confidence: 99%

“…Selective optimization of modifiable risk factors benefits patients by lessening resources and cost burdens on the health care system and allowing for better quality care. 1,3,6 There is limited but applicable literature discussing preoperative optimization in ASD. The purpose of this review is to identify modifiable risk factors and associated complications (Table 1) in patients undergoing ASD surgery and to compile recommendations for preoperative optimization (Table 2) for spine surgeons.…”

mentioning

confidence: 99%

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Preoperative Optimization for Adult Spinal Deformity Surgery

Katiyar,

Reyes,

Coury

et al. 2023

Spine

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Study Design. Systematic Review Objective. The purpose of this review is to identify modifiable risk factors in patients undergoing adult spinal deformity surgery and compile literature recommendations for preoperative optimization of these risk factors. Summary of Background Data. Optimization of modifiable risk factors not only benefits the patient but also lessens resource and cost burdens on the healthcare system, allowing for better quality and value-based care. There is limited but applicable literature discussing preoperative optimization in adult spinal deformity surgery patients specifically. Methods. We searched PubMed for studies that looked at one of the variables of interest (e.g. osteoporosis, prehabilitation and functional status, multidisciplinary preoperative screening, infection, obesity, nutrition, smoking, diabetes, blood loss, chronic opioid use and psychosocial factors) in adult patients with spinal deformity according to PRISMA guidelines. Results. 70 studies were included in the final review and synthesis of information. Guidelines and recommendations from these studies were compared and compiled into evidence based action items for preoperative optimization of modifiable risk factors prior to adult spinal deformity surgery. Conclusions. While the approach of preoperative optimization of modifiable risk factors may incur additional planning efforts and patient care time, it has the potential to significantly reduce perioperative complications and reduce morbidity and mortality during surgery, thus allowing for improved outcomes, increased quality of life, and satisfaction from this patient population. Level of Evidence. III

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