Abstract

BACKGROUND

There are no current recommendations for preoperative pulmonary evaluation and management of patients undergoing elective spine surgery.

OBJECTIVE

The aim of this guideline is to determine preoperative risk factors for perioperative and postoperative pulmonary adverse events and to determine the optimal preoperative evaluation and management of at-risk patients.

METHODS

A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to postoperative pulmonary adverse events in patients undergoing spine surgery. Clinical studies evaluating preoperative patient risk factors and preoperative diagnostic and treatment interventions were selected for review.

RESULTS

The literature search yielded 152 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 65 articles for full-text review, and 24 were selected for inclusion in this systematic review. Twenty-three articles addressed preoperative patient risk factors. One article addressed preoperative diagnostic studies of pulmonary function. There were no studies meeting the inclusion criteria for preoperative pulmonary treatment.

CONCLUSION

There is substantial evidence for multiple preoperative patient factors that predict an increased risk of a postoperative pulmonary adverse event. Individuals with these risk factors (functional dependence, advanced age [≥65 yr], chronic obstructive pulmonary disease, congestive heart failure, weight loss, and obstructive sleep apnea) who are undergoing spine surgery should be counseled regarding the potential increased risk of a perioperative and postoperative pulmonary adverse events. There is insufficient evidence to support any specific preoperative diagnostic test for predicting the risk of postoperative pulmonary adverse events or any treatment intervention that reduces risk. It is suggested, however, to consider appropriate preoperative pulmonary diagnostic testing and treatment to address active pulmonary symptoms of existing or suspected disease.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/5-preoperative-pulmonary-evaluation-optimization.

中文翻译：

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神经外科医生大会系统回顾和循证指南围手术期脊柱：术前肺部评估和优化

摘要

背景

目前尚无对接受选择性脊柱手术的患者进行术前肺部评估和管理的建议。

客观的

本指南的目的是确定围手术期和术后肺部不良事件的术前危险因素，并确定高危患者的最佳术前评估和管理。

方法

使用美国国家医学图书馆 PubMed 数据库和 Cochrane 图书馆对接受脊柱手术的患者术后肺部不良事件相关的研究进行了系统回顾。选择评估术前患者危险因素以及术前诊断和治疗干预的临床研究进行审查。

结果

文献检索产生了 152 篇与本章包含的 PICO（患者/人群、干预、比较和结果）问题相关的摘要。工作组选择了 65 篇文章进行全文审查，其中 24 篇被选中纳入本次系统评价。23 篇文章讨论了术前患者的危险因素。一篇文章讨论了肺功能的术前诊断研究。没有研究符合术前肺部治疗的纳入标准。

结论

有大量证据表明，多种术前患者因素可预测术后肺部不良事件的风险增加。有这些风险因素（功能性依赖、高龄 [≥65 岁]、慢性阻塞性肺病、充血性心力衰竭、体重减轻和阻塞性睡眠呼吸暂停）的个体，应告知正在接受脊柱手术的人可能会增加围手术期的风险和术后肺部不良事件。没有足够的证据支持任何特定的术前诊断测试来预测术后肺部不良事件的风险或降低风险的任何治疗干预。不过建议，