Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Surgical Risk Assessment.

Humans Neurosurgeons Risk Assessment Risk Factors Spinal Fusion / adverse effects Spine / surgery Surgical Wound Infection / epidemiology
Body mass index Diabetes HbA1c Preoperative evaluation Spine Tobacco

Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
13 10 2021
Historique:
received: 28 06 2021
accepted: 02 07 2021
pubmed: 8 9 2021
medline: 24 3 2022
entrez: 7 9 2021
Statut: ppublish

Résumé

Patient factors (increased body mass index [BMI], smoking, and diabetes) may impact outcomes after spine surgery. There is a lack of consensus regarding which factors should be screened for and potentially modified preoperatively to optimize outcome. The purpose of this evidence-based clinical practice guideline is to determine if preoperative patient factors of diabetes, smoking, and increased BMI impact surgical outcomes. A systematic review of the literature for studies relevant to spine surgery was performed using the National Library of Medicine PubMed database and the Cochrane Library. Clinical studies evaluating the impact of diabetes or increased BMI with reoperation and/or surgical site infection (SSI) were selected for review. In addition, the impact of preoperative smoking on patients undergoing spinal fusion was reviewed. A total of 699 articles met inclusion criteria and 64 were included in the systematic review. In patients with diabetes, a preoperative hemoglobin A1c (HbA1c) >7.5 mg/dL is associated with an increased risk of reoperation or infection after spine surgery. The review noted conflicting studies regarding the relationship between increased BMI and SSI or reoperation. Preoperative smoking is associated with increased risk of reoperation (Grade B). There is insufficient evidence that cessation of smoking before spine surgery decreases the risk of reoperation. This evidence-based guideline provides a Grade B recommendation that diabetic individuals undergoing spine surgery should have a preoperative HbA1c test before surgery and should be counseled regarding the increased risk of reoperation or infection if the level is >7.5 mg/dL. There is conflicting evidence that BMI correlates with greater SSI rate or reoperation rate (Grade I). Smoking is associated with increased risk of reoperation (Grade B) in patients undergoing spinal fusion.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/2-preoperative-surgical-risk-assessement.

Sections du résumé

BACKGROUND
Patient factors (increased body mass index [BMI], smoking, and diabetes) may impact outcomes after spine surgery. There is a lack of consensus regarding which factors should be screened for and potentially modified preoperatively to optimize outcome.
OBJECTIVE
The purpose of this evidence-based clinical practice guideline is to determine if preoperative patient factors of diabetes, smoking, and increased BMI impact surgical outcomes.
METHODS
A systematic review of the literature for studies relevant to spine surgery was performed using the National Library of Medicine PubMed database and the Cochrane Library. Clinical studies evaluating the impact of diabetes or increased BMI with reoperation and/or surgical site infection (SSI) were selected for review. In addition, the impact of preoperative smoking on patients undergoing spinal fusion was reviewed.
RESULTS
A total of 699 articles met inclusion criteria and 64 were included in the systematic review. In patients with diabetes, a preoperative hemoglobin A1c (HbA1c) >7.5 mg/dL is associated with an increased risk of reoperation or infection after spine surgery. The review noted conflicting studies regarding the relationship between increased BMI and SSI or reoperation. Preoperative smoking is associated with increased risk of reoperation (Grade B). There is insufficient evidence that cessation of smoking before spine surgery decreases the risk of reoperation.
CONCLUSION
This evidence-based guideline provides a Grade B recommendation that diabetic individuals undergoing spine surgery should have a preoperative HbA1c test before surgery and should be counseled regarding the increased risk of reoperation or infection if the level is >7.5 mg/dL. There is conflicting evidence that BMI correlates with greater SSI rate or reoperation rate (Grade I). Smoking is associated with increased risk of reoperation (Grade B) in patients undergoing spinal fusion.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/2-preoperative-surgical-risk-assessement.

Identifiants

DOI: 10.1093/neuros/nyab316 PMID: 34490886
pubmed: 34490886
pii: 6364345
doi: 10.1093/neuros/nyab316
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

S9-S18

Informations de copyright

© Congress of Neurological Surgeons 2021.

Auteurs

James S Harrop (JS)

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.

Basma Mohamed (B)

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.

Erica F Bisson (EF)

Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA.

Sanjay Dhall (S)

Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.

John Dimar (J)

Department of Orthopedics, University of Louisville, Pediatric Orthopedics, Norton Children's Hospital; Norton Leatherman Spine Center, Louisville, Kentucky, USA.

Praveen V Mummaneni (PV)

Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.

Marjorie C Wang (MC)

Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA.

Daniel J Hoh (DJ)

Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA.

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