Preoperative optimization important prior to adult spinal deformity surgery

Orthopedic Today: By Casey Tingle

Due to high complication rates associated with adult spinal deformity surgery, it is important for patients to undergo preoperative medical optimization, according to a presenter.

“A lot of authors have looked at this and have tried to provide an update on modifiable factors to reduce the risk of surgical site infections, and I think it comes down to you have to choose your adult spinal deformity patients wisely,” Jason W. Savage, MD, of the Cleveland Clinic, said in his presentation at the Lumbar Spine Research Society Annual Instructional Course. “You have to think about all of these [factors] before even considering signing these patients up for surgery.”

Savage noted patients with adult spinal deformity should quit smoking, have good control of their blood sugar, have appropriate hemoglobin levels and participate in a weight loss program if they have a BMI greater than 40 kg/m2. Savage added it is important to identify patients with chronic pain preoperatively and optimize them through a chronic pain program.

If a patient is older than 75 years of age, the patient should undergo frailty score evaluation prior to surgery, according to Savage.

“Frailty is looking at physiological age as opposed to chronological age,” Savage said in his presentation. “It has been associated with increased risk of complications, increased length of stay [and] it is also associated with discharge disposition. The frailer the patient is, the more likely they are going to need to go to a rehab facility after surgery.”

Spine surgery can be as minor as an outpatient microdiscectomy to as major as a multi-staged, multilevel spinal fusion. In order for patients to be best prepared, many concerns need to be addressed. Among these concerns is the need for patients to be in optimum health to undergo the stress of surgery and anesthesia while reducing their chances of experiencing any complications. Ideally, patients should have control of medical problems, such as diabetes and high blood pressure, and have a BMI that is below 35 kg/m2.

In addition to making sure my patients’ bodies are ready for surgery, my philosophy is that their minds be ready for surgery. I want to ensure that they totally understand the ins and outs of the procedure they are about to undergo. This includes the procedural details, possible complications and what the recovery entails. Another important part of my preoperative optimization plan is to manage each patient’s expectations regarding their condition and how the surgery will improve their quality of life and reduce pain.