Abstract

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 A_1c (HbA_1c) >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 HbA_1c 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

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：术前手术风险评估

摘要

背景

患者因素（体重指数增加 [BMI]、吸烟和糖尿病）可能会影响脊柱手术后的结果。关于哪些因素应该在术前筛查和可能进行修改以优化结果，目前缺乏共识。

客观的

本循证临床实践指南的目的是确定糖尿病、吸烟和 BMI 增加等术前患者因素是否会影响手术结果。

方法

使用国家医学图书馆 PubMed 数据库和 Cochrane 图书馆对脊柱手术相关研究的文献进行了系统回顾。选择评估糖尿病或 BMI 增加与再手术和/或手术部位感染 (SSI) 的影响的临床研究进行审查。此外，还回顾了术前吸烟对接受脊柱融合术患者的影响。

结果

共有 699 篇文章符合纳入标准，其中 64 篇被纳入系统评价。在糖尿病患者中，术前血红蛋白 A _1c (HbA _1c ) >7.5 mg/dL 与脊柱手术后再次手术或感染风险增加相关。该评价注意到关于 BMI 增加与 SSI 或再手术之间关系的相互矛盾的研究。术前吸烟与再次手术风险增加有关（B 级）。没有足够的证据表明在脊柱手术前戒烟会降低再次手术的风险。

结论

该循证指南提供了 B 级建议，即接受脊柱手术的糖尿病患者在手术前应进行术前 HbA _1c检测，如果水平 > 7.5 mg/dL，应告知再次手术或感染风险增加。有相互矛盾的证据表明 BMI 与更高的 SSI 率或再手术率相关（I 级）。在接受脊柱融合术的患者中，吸烟与再手术风险增加（B 级）相关。完整指南可在 https://www.cns.org/guidelines/browse-guidelines-detail/2-preoperative-surgical-risk 访问-评估