Journal Reading

Protocol Practice in Perioperative Management of High-Risk Patients

Undergoing Complex Spine Surgery
Sugrue PA, McClendon J, Halpin RJ, Koski TR

Presented By :
Wandry/Anggun/Nisa/Indra/Nizwan/Afifi

Advisors:
dr. Jansen
dr. Satria Prawira Putra
dr. Shandy Limansyahputra

Supervisor
Dr. dr. Karya Triko Biakto, Sp.OT(K)Spine

Orthopaedic and Traumatology Department

Medical Faculty of Hasanuddin University
Makassar
2016
 Journal Reading

ABSTRACT

The treatment of complex surgery high physiology stress

The patient must be medically fit to undergo such a procedure

The Northwestern high-risk spine protocol evaluate & treat

patients perioperative optimize outcome
 Journal Reading

INTRODUCTION

The treatment of complex spinal deformity is exceedingly

difficult

Glassman et al outlined multiple types of perioperative

complication, categorized them into major or minor

Cho et al have identified a 19.3% rate of perioperative

complication & an 18.7% rate of complications at follow-
up
 Journal Reading

INTRODUCTION
 Journal Reading

INTRODUCTION
 Journal Reading

PROTOCOL USE

The protocols are established through a multidisciplinary

process that establishes evidence-based evaluations and
interventions, and they lead to comprehensive
investigations into various comorbidities.

An essential component of this high-risk spine protocol

is that each comorbidity is assessed in the setting of the
specifics of the planned surgical intervention.
 Journal Reading

PROTOCOL USE

Pulmonary Thromboembolism

time on mechanical DVT : potential

ventilation complication after
time in ICU spinal surgery
morbidity & Start DVT prophylaxis
mortality associated immediately in
w/ acute lung injury postoperative period
Smoking cessation
must be initiated
before spinal surgery
(>8 w)
 Journal Reading

PROTOCOL USE

Cardiac

unstable coronary syndr, DHF, arrythmias, or

severe valvular disease risk of periop
cardiac complication should delayed
elective surgery
Require a cardiac stress test before surgery &
beta-blockade during surgery
90% reduction in cardiac-related events at 30
days postop. & 1- and 2-year mortality rates
 Journal Reading

PROTOCOL USE

Nutrition

Major reconstructive spinal surgery

basal metabolic needs (6-12
w)
Malnutrition nosocomial inf.
Appropriate glucose control is
associated w/ improved outcomes
 Journal Reading

PROTOCOL USE
 Journal Reading

PROTOCOL USE
 Journal Reading

PROTOCOL USE
 Journal Reading

DISCUSSION

The high-risk spine protocol as outlined by Halpin et al.

is designed to provide a framework for the complete
evaluation of patients undergoing complex medically
and technically demanding spinal surgery.

Protocol-based medical interventions not only use the

evidence available to optimize a variety of medical
comorbidities, but they also create a standardized set of
parameters that all members of the care team can
understand.
 Journal Reading

DISCUSSION

A key component of the protocol is communication.

Future directions for using this protocol include

studying the outcomes before and after the
implementation of the protocol.
TERIMA KASIH