1
|
Lamport L, DiMauro JP, Johnson S, Roberts S, Ziegler J. Association between underweight status or low body mass index and the risk of developing superior mesenteric artery syndrome following scoliosis corrective surgery in pediatric patients: a review of the literature. Spine Deform 2024:10.1007/s43390-024-00929-5. [PMID: 39046665 DOI: 10.1007/s43390-024-00929-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
Superior mesenteric artery (SMA) syndrome is the compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery. Although multifactorial, the most frequent cause of SMA syndrome is significant weight loss and cachexia often induced by catabolic stress. SMA syndrome resulting from scoliosis surgery is caused by a reduction of the aortomesenteric angle and distance. Risk factors include rapid weight loss, malnutrition, and a rapid reduction in the mesenteric fat pad and are the most common causes of a decrease in the aortomesenteric angle and distance. Surgically lengthening the vertebral column can also lead to a reduction of the aortomesenteric distance, therefore, has been identified as a risk factor unique to spinal surgery. Despite a reported decline in SMA syndrome cases due to improved surgical techniques, duodenal compression is still a risk and remains a life-threatening complication of scoliosis surgery. This article is a cumulative review of the evidence of being underweight or having a low body mass index as risk factors for developing SMA syndrome following surgical scoliosis instrumentation and correction.
Collapse
Affiliation(s)
- Lyssa Lamport
- Cohen Children's Medical Center of New York, New Hyde Park, New York, USA.
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA.
| | - Jon-Paul DiMauro
- Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
- Zucker School of Medicine at Hofstra/Northwell, Orthopedic Surgery, Hempstead, New York, USA
| | - Stephani Johnson
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Susan Roberts
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| |
Collapse
|
2
|
Álvarez-Galovich L, Ley Urzaiz L, Martín-Benlloch JA, Calatayud Pérez J. Recommendations for enhanced post-surgical recovery in the spine (REPOC). Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:83-93. [PMID: 36240991 DOI: 10.1016/j.recot.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Enhanced recovery after surgery (ERAS) constitutes a multimodal approach, based on available scientific evidence, that achieves better patient's functionality, reduces pain, and even lowers financial costs. The present consensus statement proposes the standards for the implementation of ERAS programs to lumbar fusion surgery, a meant benchmark we call REPOC. METHODOLOGY A multidisciplinary group of experts was set up ad hoc to review consensus recommendations for lumbar arthrodesis, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS As a result, 23 recommendations were selected throughout the preoperative, intraoperative, and postoperative phases of the surgical procedure. A 29-item checklist was also drawn up to implement REPOC protocols in spinal surgeries. CONCLUSIONS This list of recommendations will facilitate the implementation of this multimodal approach as a safe and effective tool for reducing adverse events in our environment.
Collapse
Affiliation(s)
- L Álvarez-Galovich
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - L Ley Urzaiz
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J A Martín-Benlloch
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna. Hospital Universitario Dr. Peset de Valencia, Valencia, España
| | - J Calatayud Pérez
- Servicio de Neurocirugía, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| |
Collapse
|
3
|
Alvarez-Galovich L, Ley Urzaiz L, Martín-Benlloch JA, Calatayud Pérez J. [Translated article] Recommendations for enhanced post-surgical recovery in the spine (REPOC). Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T83-T93. [PMID: 36535345 DOI: 10.1016/j.recot.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Enhanced recovery after surgery (ERAS) constitutes a multimodal approach, based on available scientific evidence, that achieves better patient's functionality, reduces pain, and even lowers financial costs. The present consensus statement proposes the standards for the implementation of ERAS programmes to lumbar fusion surgery, a meant benchmark we call REPOC. METHODOLOGY A multidisciplinary group of experts was set up ad hoc to review consensus recommendations for lumbar arthrodesis, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS As a result, 23 recommendations were selected throughout the preoperative, intraoperative, and postoperative phases of the surgical procedure. A 29-item checklist was also drawn up to implement REPOC protocols in spinal surgeries. CONCLUSIONS This list of recommendations will facilitate the implementation of this multimodal approach as a safe and effective tool for reducing adverse events in our environment.
Collapse
Affiliation(s)
- L Alvarez-Galovich
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - L Ley Urzaiz
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J A Martín-Benlloch
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna. Hospital Universitario Dr. Peset de Valencia, Valencia, Spain
| | - J Calatayud Pérez
- Servicio de Neurocirugía, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| |
Collapse
|
4
|
Yuan Y, Wang SK, Chai XY, Wang P, Li XY, Kong C, Lu SB. The implementation of enhanced recovery after surgery pathway in patients undergoing posterior thoracolumbar fusion for degenerative spinal deformity. BMC Musculoskelet Disord 2023; 24:29. [PMID: 36639811 PMCID: PMC9837952 DOI: 10.1186/s12891-023-06146-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The prevalence of degenerative spinal deformity (DSD) and the increased cost of correction surgery impose substantial burdens on the health care and insurance system. The aim of our study was to investigate the effects of the implementation of Enhanced Recovery After Surgery (ERAS) protocol on postoperative outcomes after complex spinal surgery. METHODS A retrospective analysis of prospectively established database of DSD was performed. The consecutive patients who underwent open correction surgery for degenerative spinal deformity between August 2016 and February 2022 were reviewed. We extracted demographic data, preoperative radiographic parameters, and surgery-related variables. The ERAS patients were 1:1 propensity-score matched to a historical cohort by the same surgical team based on age, gender, BMI, and number of levels fused. We then compared the length of hospital stay (LOS), physiological functional recovery, and the rates of complications and readmissions within 90 days after surgery between the groups. RESULTS There were 108 patients included, 54 patients in the ERAS cohort, and 54 patients matched control patients in the historical cohort. The historical and ERAS cohorts were not significantly different regarding demographic characteristics, comorbidities, preoperative parameters, operative time, and reoperation rate (P > 0.05). Patients in the ERAS group had significantly shorter postoperative LOS (12.0 days vs. 15.1 days, P = 0.001), average days of drain and urinary catheters placement (3.5 days vs. 4.4 days and 1.9 days vs 4.8 days, respectively), and lower 90-day readmission rate (1.8% vs. 12.9%, P = 0.027). The first day of assisted-walking and bowel movement occurred on average 1.9 days (2.5 days vs. 4.4 days, P = 0.001) and 1.7 days (1.9 days vs. 3.6 days, P = 0.001) earlier respectively in the ERAS group. Moreover, the rate of postoperative urinary retention (3.7% vs. 16.7%, P = 0.026) and surgical site infection (0% vs. 7.4%, P = 0.046) were significantly lower with ERAS protocol applied. CONCLUSIONS Our study confirmed that the ERAS protocol was safe and essential for patients undergoing thoracolumbar deformity surgery for DSD. The ERAS protocol was associated with a shorter postoperative LOS, a lower rate of 90-day readmission, less rehabilitation discharge, and less postoperative complications.
Collapse
Affiliation(s)
- Yi Yuan
- Department of Orthopedics, No.6 Hospital, Beijing, 100007 China
| | - Shuai-Kang Wang
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Xin-Yi Chai
- grid.24696.3f0000 0004 0369 153XCapital Medical University, Beijing, 10053 China
| | - Peng Wang
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Xiang-Yu Li
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Chao Kong
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Shi-Bao Lu
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| |
Collapse
|
5
|
Mohamed B, Ramachandran R, Rabai F, Price CC, Polifka A, Hoh D, Seubert CN. Frailty Assessment and Prehabilitation Before Complex Spine Surgery in Patients With Degenerative Spine Disease: A Narrative Review. J Neurosurg Anesthesiol 2023; 35:19-30. [PMID: 34354024 PMCID: PMC8816967 DOI: 10.1097/ana.0000000000000787] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 02/07/2023]
Abstract
Degenerative spine disease increases in prevalence and may become debilitating as people age. Complex spine surgery may offer relief but becomes riskier with age. Efforts to lessen the physiological impact of surgery through minimally invasive techniques and enhanced recovery programs mitigate risk only after the decision for surgery. Frailty assessments outperform traditional tools of perioperative risk stratification. The extent of frailty predicts complications after spine surgery such as reoperation for infection and 30-day mortality, as well as elements of social cost such as hospital length of stay and discharge to an advanced care facility. Symptoms of spine disease overlap with phenotypic markers of frailty; therefore, different frailty assessment tools may perform differently in patients with degenerative spine disease. Beyond frailty, however, cognitive decline and psychosocial isolation may interact with frailty and affect achievable surgical outcomes. Prehabilitation, which has reduced perioperative risk in colorectal and cardiac surgery, may benefit potential complex spine surgery patients. Typical prehabilitation includes physical exercise, nutrition supplementation, and behavioral measures that may offer symptomatic relief even in the absence of surgery. Nonetheless, the data on the efficacy of prehabilitation for spine surgery remains sparse and barriers to prehabilitation are poorly defined. This narrative review concludes that a frailty assessment-potentially supplemented by an assessment of cognition and psychosocial resources-should be part of shared decision-making for patients considering complex spine surgery. Such an assessment may suffice to prompt interventions that form a prehabilitation program. Formal prehabilitation programs will require further study to better define their place in complex spine care.
Collapse
Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Ramani Ramachandran
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Ferenc Rabai
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
| | - Adam Polifka
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Daniel Hoh
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Christoph N. Seubert
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
| |
Collapse
|
6
|
Abstract
Enhanced recovery after surgery (ERAS) protocols are a set of interventions which are carried out in the preoperative and perioperative period. They are aimed to decrease the harmful effects of surgery on the body and help the patient recover better post-surgery. The effectiveness of ERAS has been well established in various other surgical specialities. Earlier spine surgery was thought to be very complex for application of ERAS protocols. However, this has changed over the last decade with (ERAS) protocols gaining widespread popularity in spine surgery. Initial studies involving ERAS in spine surgery were limited to lumbar spine. However, over the years the horizon of ERAS has expanded to include anterior cervical surgeries, spine deformity, spinal tumors and spine surgery in the elderly. ERAS has been shown to reduce the length of hospital stay, overall hospital costs, opioid consumption in perioperative and postoperative period and to lower complication rates in spine surgery. In this narrative review, we discuss various aspects of ERAS in spine surgery including the benefits of ERAS in spine surgery, the various components of preoperative, intraoperative and postoperative measures of ERAS protocol.
Collapse
|
7
|
Gao G, Zhou C, Ao Y, Wang J, Xu Y. Variations in postoperative electrolyte concentrations and influential factors in hip arthroscopy. BMC Musculoskelet Disord 2022; 23:473. [PMID: 35590402 PMCID: PMC9118850 DOI: 10.1186/s12891-022-05451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different from arthroscopy in other joints, more perfusion is required for a better access to perform surgical procedures in hip arthroscopic operations. The significant fluid perfused may lead to complications of partial tissue injury and electrolyte imbalance. However, there were few studies on the change of serum electrolyte after hip arthroscopy and the influential factors were still unknown. METHODS We evaluated consecutive patients who underwent hip arthroscopy in our hospital between October 2021 and February 2022. Age, sex, and BMI matched patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at the same time were also included as the control group. Preoperative and postoperative serum electrolyte of sodium (Na +), potassium (K +), chloride (Cl-), magnesium (Mg2 +), and carbon dioxide capacity (CO2CP) were analyzed. The correlations between influential factors like perfusion volume, operating time, BMI and hip circumference, and changes in serum electrolyte were also analyzed. RESULTS A total of 79 patients were involved in this study, including 49 patients who underwent hip arthroscopy and 30 patients who underwent knee arthroscopy. For hip arthroscopy, decrease of potassium levels was observed in 40.8% of the patients, and postoperative hypokalemia was found in 10.2% patients. There were significant variations in postoperative sodium, magnesium, chloride and carbon dioxide capacity in hip arthroscopy (p < 0.05). No correlations were found between each of the electrolyte concentrations and influential factors like perfusion volume, operating time, BMI, sex and hip circumference. The significant variations were found in chloride and carbon dioxide capacity in knee arthroscopy (p < 0.05). CONCLUSIONS Hip arthroscopy would significantly influence postoperative serum electrolyte, and hypokalemia could be a postoperative complication. The correlation between serum electrolyte and fluid perfusion volume is remained to be investigated. We therefor advocate that performing a systematic care of preoperative and postoperative serum electrolyte analysis as perioperative management is necessary.
Collapse
Affiliation(s)
- Guanying Gao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Chang Zhou
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Jianquan Wang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Yan Xu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China.
| |
Collapse
|
8
|
Wang W, Wang P, Kong C, Teng Z, Zhang S, Sun W, Lu S. Retrospective Data Analysis for Enhanced Recovery After Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion. World Neurosurg 2022; 164:e397-e403. [PMID: 35513281 DOI: 10.1016/j.wneu.2022.04.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) for spinal surgery is new; specifically, an ERAS program for elderly patients is lacking. Geriatric patients have special characteristics that result in further harm by surgical stress. ERAS interventions are designed to improve recovery after surgery and can result in substantial benefits in clinical outcomes and cost-effectiveness. We aimed to determine whether ERAS significantly improved satisfaction and outcomes in elderly patients with long-level lumbar fusion. METHODS Patients >70 years old with lumbar disc herniation or lumbar spinal stenosis who underwent lumbar fusion of ≥3 levels from July 2019 to June 2021 (ERAS group) and from January 2018 to June 2019 (non-ERAS group) were enrolled. Demographic, comorbidity, and surgical data were collected from electronic medical records. ERAS interventions were categorized as preoperative, intraoperative, and postoperative. We also evaluated primary outcome, surgical complications, and length of stay (LOS). RESULTS The study included 154 patients, 72 in the ERAS group and 82 case-matched patients in the non-ERAS group. Overall, ERAS pathway compliance was 91%. There were no significant differences in readmission and mortality rates at 30-day follow-up between the ERAS and non-ERAS groups. Statistically significant decreases were observed in the ERAS group in complications (6 in ERAS group vs. 19 in non-ERAS group, P = 0.013) and LOS (17.74 ± 5.56 days in ERAS group vs. 22.13 ± 12.21 days in non-ERAS group, P = 0.041). Multivariable linear regression showed that implementation of ERAS (P = 0.002) was correlated with LOS. Multivariable logistic regression showed that implementation of ERAS (P = 0.004) was correlated with complications. CONCLUSIONS The ERAS protocol used in elderly patients after long-level lumbar fusion surgery was safe and associated with incremental benefits regarding complications and LOS.
Collapse
Affiliation(s)
- Wei Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Ze Teng
- Department of Radiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Sitao Zhang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Wenzhi Sun
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China.
| |
Collapse
|
9
|
Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, González-Navarro I, Remón-Ruíz PJ, Pereira-Cunill JL, García-Luna PP. Perioperative Nutritional Support: A Review of Current Literature. Nutrients 2022; 14:1601. [PMID: 35458163 PMCID: PMC9030898 DOI: 10.3390/nu14081601] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/27/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
Since the beginning of the practice of surgery, the reduction of postoperative complications and early recovery have been two of the fundamental pillars that have driven the improvement of surgical techniques and perioperative management. Despite great advances in these fields, the rationalization of antibiotic prophylaxis, and other important innovations, postoperative recovery (especially in elderly patients, oncological pathology or digestive or head and neck surgery) is tortuous. This can be explained by several reasons, among which, malnutrition has a major role. Perioperative nutritional support, included within the ERAS (Enhanced Recovery After Surgery) protocol, has proven to be a main element and a critical step to achieve better surgical results. Starting with the preoperative nutritional assessment and treatment in elective surgery, we can improve nutritional status using oral supplements and immunomodulatory formulas. If we add early nutritional support in the postoperative scenario, we are able to significantly reduce infectious complications, need for intensive care unit (ICU) and hospital stay, costs, and mortality. Throughout this review, we will review the latest developments and the available literature.
Collapse
Affiliation(s)
| | | | | | | | | | - José Luís Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.J.M.-O.); (A.P.-G.); (P.S.-A.); (I.G.-N.); (P.J.R.-R.); (P.P.G.-L.)
| | | |
Collapse
|
10
|
Wang S, Wang P, Li X, Sun W, Kong C, Lu S. Enhanced recovery after surgery pathway: association with lower incidence of wound complications and severe hypoalbuminemia in patients undergoing posterior lumbar fusion surgery. J Orthop Surg Res 2022; 17:178. [PMID: 35331289 PMCID: PMC8944146 DOI: 10.1186/s13018-022-03070-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Wound complications are associated with worse satisfaction and additional costs in patients undergoing posterior lumbar fusion (PLF) surgery, and the relationship between enhanced recovery after surgery (ERAS) pathway and wound complications remains poorly characterized. Methods In this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between the ERAS program and the incidence of postoperative wound-related complications and other complications following PLF surgery; other outcomes included the length of stay (LOS), 90-day hospital and rehabilitation center readmission. Results The average patient age was 65 yr. More patients with old cerebral infarction were in ERAS group (p < 0.01), and other demographics and comorbidities were similar between groups. Patients in the ERAS group had a lower incidence of postoperative wound-related complications than the non-ERAS group (12.4 vs. 17.8%, p = 0.02). The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing (6% vs. 3%, p = 0.02). ERAS group had a lower incidence of severe postoperative hypoalbuminemia (serum albumin less than 30 g/L) (15.8% vs. 9.0% p < 0.01). Additionally, ERAS patients had shorter postoperative LOS (8.0 ± 1.5 vs. 9.5 ± 1.7, p < 0.01), lower rate of readmission within 90 days (1.9% vs. 6.4%, p < 0.01) and discharge to rehabilitation center (4.2% vs. 1.0%, p < 0.01). Conclusion ERAS pathway might help decrease the rates of postoperative wound complications and severe hypoalbuminemia following PLF surgery; additionally, it demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90 days.
Collapse
Affiliation(s)
- Shuaikang Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Xiangyu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Wenzhi Sun
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China. .,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China. .,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.
| |
Collapse
|
11
|
Briguglio M, Perazzo P, Langella F, Crespi T, De Vecchi E, Riso P, Porrini M, Scaramuzzo L, Bassani R, Brayda-Bruno M, Banfi G, Berjano P. Prediction of Long-Term Recovery From Disability Using Hemoglobin-Based Models: Results From a Cohort of 1,392 Patients Undergoing Spine Surgery. Front Surg 2022; 9:850342. [PMID: 35372461 PMCID: PMC8966424 DOI: 10.3389/fsurg.2022.850342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Hemoglobin and its associated blood values are important laboratory biomarkers that mirror the strength of constitution of patients undergoing spine surgery. Along with the clinical determinants available during the preadmission visit, it is important to explore their potential for predicting clinical success from the patient's perspective in order to make the pre-admission visit more patient-centered. We analyzed data from 1,392 patients with spine deformity, disc disease, or spondylolisthesis enrolled between 2016 and 2019 in our institutional Spine Registry. Patient-reported outcome measure at 17 months after surgery was referred to the Oswestry disability index. High preoperative hemoglobin was found to be the strongest biochemical determinant of clinical success along with high red blood cells count, while low baseline disability, prolonged hospitalization, and long surgical times were associated with poor recovery. The neural network model of these predictors showed a fair diagnostic performance, having an area under the curve of 0.726 and a sensitivity of 86.79%. However, the specificity of the model was 15.15%, thus providing to be unreliable in forecasting poor patient-reported outcomes. In conclusion, preoperative hemoglobin may be one of the key biomarkers on which to build appropriate predictive models of long-term recovery after spine surgery, but it is necessary to include multidimensional variables in the models to increase the reliability at the patient's level.
Collapse
Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
- *Correspondence: Matteo Briguglio
| | - Paolo Perazzo
- IRCCS Orthopedic Institute Galeazzi, Intensive Care Unit, Milan, Italy
| | | | - Tiziano Crespi
- IRCCS Orthopedic Institute Galeazzi, Intensive Care Unit, Milan, Italy
| | - Elena De Vecchi
- IRCCS Orthopedic Institute Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Patrizia Riso
- University of Milan, Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Milan, Italy
| | - Marisa Porrini
- University of Milan, Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Milan, Italy
| | | | - Roberto Bassani
- IRCCS Orthopedic Institute Galeazzi, Spine Unit 2, Milan, Italy
| | | | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
- Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milan, Italy
| | - Pedro Berjano
- IRCCS Orthopedic Institute Galeazzi, GSpine 4, Milan, Italy
| |
Collapse
|
12
|
Development and Validation of a Nomogram for Predicting Albumin Transfusion After Spinal Tuberculosis Surgery: Based on Propensity Score Matching Analysis. World Neurosurg 2021; 157:e374-e389. [PMID: 34662656 DOI: 10.1016/j.wneu.2021.10.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There have been few literature reports on the use of perioperative parameters to predict the risk of albumin transfusion after spinal tuberculosis surgery based on the application of nomogram and propensity score matching (PSM) analysis. OBJECTIVE The purpose was to predict the risk of albumin transfusion after spinal tuberculosis surgery based on a combination of PSM and nomogram. METHODS The clinical data of the patients were collected in our hospital, including preoperative clinical data, preoperative laboratory tests, and postoperative clinical data. All data were divided into 2 groups, including the albumin transfusion group and the non-albumin transfusion group. The PSM analysis was used to adjust the baseline data of the 2 groups. The nomogram was further constructed. The practicability and predictive ability of the model were evaluated. RESULTS A total of 494 cases were collected in this article; 102 pairs by PSM analysis were used to construct the nomogram. There were statistical differences in surgical approach, aspartate aminotransferase/alanine aminotransferase levels, drainage, and kyphosis by logistic analysis, and these parameters were included in the construction of the nomogram. The C-index of the prediction model was 0.734. The area under the curve was 0.73 and the net benefit was between 0.13 and 0.99. The calculated C-index was 0.71 by the internal verification method. CONCLUSIONS The PSM analysis had a good matching effect and the nomogram had a good predictive ability. Surgical approach, aspartate aminotransferase/alanine aminotransferase levels, drainage, and kyphosis might be predictors of albumin transfusion after spinal tuberculosis surgery.
Collapse
|
13
|
Bisson EF, Dimar J, Harrop JS, Hoh DJ, Mohamed B, Mummaneni PV, Wang MC, Dhall S. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Nutritional Assessment. Neurosurgery 2021; 89:S26-S32. [PMID: 34490884 DOI: 10.1093/neuros/nyab318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preoperative malnutrition has been implicated in adverse events after elective surgery, potentially impacting patient outcomes. OBJECTIVE As a potentially modifiable risk factor, we sought to determine which assessments of nutritional status were associated with specific adverse events after spine surgery. In addition, we explored if a preoperative nutritional improvement intervention may be beneficial in lowering the rates of these adverse events. METHODS The literature search yielded 115 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 105 articles for full text review, and 13 met criteria for inclusion in this systematic review. RESULTS Malnutrition, assessed preoperatively by a serum albumin <3.5 g/dL or a serum prealbumin <20 mg/dL, is associated with a higher rate of surgical site infections (SSIs), other wound complications, nonunions, hospital readmissions, and other medical complications after spine surgery. A multimodal nutrition management protocol decreases albumin and electrolyte deficiencies in patients with normal preoperative nutritional status. It also improves overall complication rates but does not specifically impact SSIs. CONCLUSION It is recommended to assess nutritional status using either serum albumin or prealbumin preoperatively in patients undergoing spine surgery.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/4-preoperative-nutritional-assessment.
Collapse
Affiliation(s)
- Erica F Bisson
- Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
| | - John Dimar
- Department of Orthopedics, University of Louisville, Pediatric Orthopedics, Norton Children's Hospital, Norton Leatherman Spine Center, Louisville, Kentucky, USA
| | - James S Harrop
- Department of Neurological Surgery and Department of Orthopedic Surgery, Thomas Jefferson University, Division of Spine and Peripheral Nerve Surgery, Delaware Valley SCI Center, Philadelphia, Pennsylvania, USA
| | - Daniel J Hoh
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Basma Mohamed
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Marjorie C Wang
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Sanjay Dhall
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
14
|
Kurosu K, Oe S, Hasegawa T, Shimizu S, Yoshida G, Kobayashi S, Fujita T, Yamada T, Ide K, Watanabe Y, Nakai K, Yamato Y, Yasuda T, Banno T, Arima H, Mihara Y, Ushirozako H, Matsuyama Y. Preoperative prognostic nutritional index as a predictive factor for medical complication after cervical posterior decompression surgery: A multicenter study. J Orthop Surg (Hong Kong) 2021; 29:23094990211006869. [PMID: 33832377 DOI: 10.1177/23094990211006869] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective longitudinal cohort study. OBJECTIVE To investigate postoperative medical complications in patients with malnutrition after cervical posterior surgery. METHODS A total of 256 patients were participated and divided into PNI < 50 group (group L) or PNI ≥ 50 (group H). Patient data, preoperative laboratory data, surgical data, hospitalization data, JOA score, complication data were measured. RESULTS Group L and group H were 127 and 129 patients, each PNI was L: 44.8 ± 4.3, H: 54.6 ± 4.0, P < 0.01. There was significant difference in mean age (L: 72.2 years vs H: 64.8 years, P < 0.01), BMI (23.1 vs 24.7, P < 0.01), serum albumin (L: 3.9 ± 0.4 g/dl vs H: 4.4 ± 0.3 g/dl, P < 0.01), total lymphocyte count (L: 1.3 ± 0.5 103/µL vs H: 2.1 ± 0.7 103/μL, P < 0.01), hospital stay (L: 25.0 days vs H: 18.8 days, P < 0.05), discharge to home (87.5% vs 57.5%, P < 0.01), delirium (L: 15.9% vs H: 3.9%, P < 0.01), medical complications (L: 25.2% vs H: 7.0%, P < 0.01), pre- and post- operative JOA score (L: 11.3 ± 2.8 vs H: 12.4 ± 2.6, P < 0.01; L: 13.3 ± 3.0 vs H: 14.1 ± 2.4, P = 0.02). Multiple logistic regression analysis showed that significant risk factors for medical complications were PNI<50 (P = 0.024, odds ratio [OR] 2.746, 95% confidence interval [CI] 1.143-6.600) and age (P = 0.005, odds ratio [OR] 1.064, 95% confidence interval [CI] 1.020-1.111). CONCLUSION Medical complications are significantly higher in patients with PNI < 50 and higher age. The results showed that PNI is a good indicator for perioperative medical complications in cervical posterior surgery. Improvement of preoperative nutritional status is important to avoid medical complications. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Kenta Kurosu
- Department of Orthopedic Surgery, Shizuoka City Hospital, Shizuoka City, Japan.,Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery, Haibara General Hospital, Haibara, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery, Japanese Red Cross Hamamatsu Hospital, Hamamatsu, Japan
| | - Satoshi Shimizu
- Department of Orthopedic Surgery, 13698Narita Memorial Hospital, Toyohashi, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery, Aoyama Hospital, Toyokawa, Japan
| | - Sho Kobayashi
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Tomotada Fujita
- Department of Orthopedic Surgery, Enshu Hospital, Hamamatsu, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery, Kikugawa General Hospital, Kikugawa, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiichi Nakai
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery, 13773Iwata City Hospital, Iwata, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Orthopedic Surgery, 13773Iwata City Hospital, Iwata, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, 12793Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
15
|
Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Le Huec JC, Fawcett WJ, Ljungqvist O, Lonjon G, de Boer HD. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J 2021; 21:729-752. [PMID: 33444664 DOI: 10.1016/j.spinee.2021.01.001] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery. PURPOSE This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program. STUDY DESIGN This is a review article. METHODS Under the impetus of the ERAS® society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature. RESULTS Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented. CONCLUSION Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS® Society presents this comprehensive consensus review for perioperative care in lumbar fusion.
Collapse
Affiliation(s)
- Bertrand Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
| | - Thomas W Wainwright
- Research Institute, Bournemouth University, Bournemouth, UK; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Bournemouth, UK
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Freyr G Sigmundsson
- Department of Orthopedic Surgery, Örebro University Hospital, Södra Grev Rosengatan, Örebro, Sweden
| | - Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Aurélien Bonnal
- Department of Anesthesiology, Clinique St-Jean- Sud de France, Santécité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery - Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean- Sud de France, SantéCité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, the Netherlands
| |
Collapse
|
16
|
Li ZE, Lu SB, Kong C, Sun WZ, Wang P, Zhang ST. Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and non-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study. BMC Musculoskelet Disord 2021; 22:283. [PMID: 33731057 PMCID: PMC7968191 DOI: 10.1186/s12891-021-04166-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background Enhanced recovery after surgery (ERAS) program is an evidence-based improvement over non-ERAS traditional care. The aim of the present study was to analyze the safety, feasibility, and efficacy of an ERAS program in patients over 70 years undergoing lumbar arthrodesis by comparison with non-ERAS traditional care. Methods During January 2018 to December 2018, patients enrolled received non-ERAS traditional care, while the ERAS program was implemented from January to December 2019. Demographic characteristics, comorbidities, surgical data and postoperative recovery parameters were collected from all patients. Postoperative pain scores were evaluated by visual analog scales (VAS). The clinical outcomes were length of stay (LOS), postoperative complications and postoperative pain scores. Compliance results were also collected. Result A total of 127 patients were enrolled, including 67 patients in the non-ERAS traditional care group and 60 patients in the ERAS group. The demographic characteristics and comorbidities of the two groups showed no significant differences. The LOS of patients treated with ERAS program (13.6 ± 4.0 days) was significantly less than that of patients treated with non-ERAS traditional care (15.6 ± 3.9 days) (p = 0.034). Complication rate was 8.3% in the ERAS group versus 20.9% in the non-ERAS traditional care group (p = 0.048). VAS (back) in the ERAS group was significantly lower on postoperative day (POD) 1 and POD2. Postoperative recovery parameters were improved in the ERAS group. The overall compliance with the ERAS program was 94%. Conclusions Based on our results, ERAS program is safer and more effective for elderly patients over 70 undergoing lumbar arthrodesis than non-ERAS traditional care.
Collapse
Affiliation(s)
- Zhong-En Li
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China.,Capital Medical University, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, China.
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China.,Capital Medical University, Beijing, China
| | - Wen-Zhi Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China.,Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China.,Capital Medical University, Beijing, China
| | - Si-Tao Zhang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| |
Collapse
|
17
|
Pennington Z, Bomberger TT, Lubelski D, Benzel EC, Steinmetz MP, Mroz TE. Associations Between Preoperative Hyponatremia and 30-Day Perioperative Complications in Lumbar Interbody Spinal Fusion. Clin Spine Surg 2021; 34:E7-E12. [PMID: 32467442 DOI: 10.1097/bsd.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective population database study. OBJECTIVE To investigate the relationship of preoperative hyponatremia to postoperative morbidity and mortality in lumbar interbody fusion patients. SUMMARY OF BACKGROUND DATA Optimization of preoperative patient selection and perioperative management can improve patient outcomes in spinal surgery. Hyponatremia, incidentally identified in 1.7% of the US population, has previously been tied to poorer postoperative outcomes in both the general surgery and orthopedic surgery populations. MATERIALS AND METHODS Using the National Surgical Quality Improvement Program database, the authors identified all lumbar interbody fusion patients treated between 2012 and 2014. Patients were classified as hyponatremic (Na<135 mEq/L) or as having normal sodium levels (135-145 mEq/L) preoperatively. The primary outcome was major morbidity and secondary endpoints were prolonged hospitalization, 30-day readmission, and reoperation. Multivariable linear regression was used to find independent predictors of these outcomes. RESULTS Of 10,654 patients, 45.6% were male individuals, 5.5% were hyponatremic, and 4.2% experienced a major postoperative complication. On multivariable analysis, preoperative hyponatremia was independently associated with major morbidity (odds ratio, 1.22; 95% confidence interval, 1.03-1.44; P<0.05) and prolonged hospitalization (odds ratio, 1.14; 95% confidence interval, 1.02-1.27). CONCLUSIONS Here the authors provide the first evidence suggesting preoperative hyponatremia is an independent predictor of major morbidity after lumbar interbody fusion. Hyponatremia may represent a modifiable risk factor for improved patient care and preoperative risk counseling.
Collapse
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edward C Benzel
- Cleveland Clinic Center for Spine Health
- Department of Neurological Surgery, Cleveland Clinic
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Michael P Steinmetz
- Cleveland Clinic Center for Spine Health
- Department of Neurological Surgery, Cleveland Clinic
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| |
Collapse
|
18
|
Wang P, Wang Q, Kong C, Teng Z, Li Z, Zhang S, Sun W, Feng M, Lu S. Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion. J Orthop Surg Res 2020; 15:299. [PMID: 32762762 PMCID: PMC7409683 DOI: 10.1186/s13018-020-01814-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (> 65 years old) with short-level lumbar fusion. Methods The study enrolled lumbar disc herniation or lumbar spinal stenosis patients if they were over the age of 65 years old underwent lumbar fusion at one or two levels. Data including demographic, comorbidity, and surgical information were collected from electronic medical records. Enhanced recovery after surgery interventions was categorized as preoperative, intraoperative, and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores, and 30-day readmission rates. Results A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. There were no statistically significant intergroup differences in regards to demographics, comorbidities, American Society of Anaesthesiologists grade, or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score, visual analog score for the back and legs, and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non-enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score, Visual analog score for the back and legs, Oswestry Disability Index score, and readmission rates score revealed no significant differences between the groups at 30-day follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30 ± 3.03 of enhanced recovery after surgery group versus 15.50 ± 1.88 in non- enhanced recovery after surgery group, p = 0). Multivariable linear regression showed that comorbidities (p = 0.023) and implementation of enhanced recovery after surgery program (p = 0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. Conclusions This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decrease length of stay in elderly patients with short-level lumbar fusion.
Collapse
Affiliation(s)
- Peng Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Qiang Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Ze Teng
- Department of Radiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, People's Republic of China
| | - Zhongen Li
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Sitao Zhang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Wenzhi Sun
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Mingli Feng
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
| |
Collapse
|
19
|
Pennington Z, Bomberger TT, Lubelski D, Benzel EC, Steinmetz MP, Mroz TE. Preoperative Hyponatremia and Perioperative Complications in Cervical Spinal Fusion. World Neurosurg 2020; 141:e864-e872. [PMID: 32553754 DOI: 10.1016/j.wneu.2020.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Preoperative patient optimization is increasingly recognized as key to good surgical outcomes. Preoperative hyponatremia is a modifiable risk factor linked to poorer postoperative outcomes in other surgical fields. We provide the first investigation of the association of preoperative hyponatremia with morbidity and mortality in patients undergoing cervical spine surgery. METHODS We queried the National Surgical Quality Improvement Program registry for patients who underwent cervical spine fusion. Preoperative serum sodium levels were classified as normal (135-145 mEq/L) or hyponatremic (<135 mEq/L); hypernatremic patients were excluded from the analysis. Multivariable logistic analyses using a multiple imputations methodology were performed to determine significant predictors of major morbidity and mortality (MMM). RESULTS We included 20,817 patients, of whom 5.2% were hyponatremic at presentation. Preoperative hyponatremia was a significant predictor of MMM (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.09-1.39), mortality (OR, 1.36; 95% CI, 1.03-1.77), major morbidity (OR, 1.24; 95% CI, 1.10-1.40), and odds of prolonged hospitalization (OR, 1.13; 95% CI, 1.04-1.23). Other significant predictors of MMM included age, undergoing an emergent versus nonemergent operation, having chronic obstructive pulmonary disease, having disseminated malignancy, being functionally dependent, presenting with sepsis or septic shock, and having an American Society of Anesthesiologists status of 3, 4, or 5. Similar results were seen in analyses using only complete cases and in sensitivity analyses. CONCLUSIONS Using the National Surgical Quality Improvement Program database, hyponatremia is observed in approximately 1 in every 20 patients undergoing cervical spine fusion. More importantly, it is a predictor of mortality, major morbidity, and prolonged hospitalization. From a systems-level perspective, preoperative hyponatremia may therefore represent a point of intervention for preoperative patient optimization.
Collapse
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas T Bomberger
- Department of Diagnostic Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward C Benzel
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA; The Cleveland Clinic, Lerner College of Medicine, Cleveland, Ohio, USA
| | - Michael P Steinmetz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA; The Cleveland Clinic, Lerner College of Medicine, Cleveland, Ohio, USA
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA; The Cleveland Clinic, Lerner College of Medicine, Cleveland, Ohio, USA; Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA.
| |
Collapse
|