If you experience spinal symptoms that require surgery, you choose a surgeon based on their ability to diagnose the problem and execute the surgical technique effectively. You trust your surgeon to make the best choices surrounding your surgery to ensure an optimal recovery.
But even when surgical planning and the operation goes perfect from a technical standpoint, there are still things that the patient controls that can affect the surgery positively or negatively. Patients may be unaware that some behaviors can have such an important effect on surgical outcome. These factors include obesity, diabetes management, smoking, nutrition and preoperative narcotic use.
- Obesity has the potential to affect outcomes of spinal surgery in various ways. Challenges during your operation may include requiring the surgeon to make a larger incision and longer operative time. There is also a risk of increased blood loss and overall intraoperative complications.
Post operative complications can arise from obesity with BMI greater than 35. Obesity is defined as a Body Mass Index greater than 30. BMI is a measurement of body fat based on height and weight, and can be calculated by taking your weight in kilograms and dividing it by your height in meters. Post operative complications can include surgical site infection, blood clots in the legs or lungs, pneumonia and risk of re-operation.
Weight loss preoperatively is a modifiable risk factor that can improve your overall intraoperative and postoperative experience.
- Diabetes is a result of your body’s inability to produce or use insulin. This can result in elevated blood sugar levels. Diabetes is known to cause issues with slow healing and this is no different when it comes to spinal surgery. Hemoglobin A1C levels are an estimate of someone’s blood sugar levels over 3 months. A1C levels greater than 7.5 can increase a patient’s surgical risks including infection and hospital length of stay. Close management of diabetes with medication compliance and following strict diet parameters can decrease major risk factors associated with surgery.
- Smoking cessation is crucial prior to surgery. The use of tobacco is a well-known risk factor for surgical site infection, slow wound healing, deep vein thrombosis and nonunion to fused segments in the spine.
- Appropriate nutrition can be measured by simple blood tests. One of these tests is called a serum albumin. A low albumin preoperatively can suggest the patient may need to modify their nutritional intake prior to and after surgery for appropriate healing. A healthy diet of balanced protein and carbohydrates may improve overall complication rates.
- Most spine surgery candidates have been experiencing a significant amount of pain which leads them to consider surgery. Sometimes narcotic pain medication is used to help manage the symptoms. If narcotic pain medication is used before surgery, post op pain control can be harder to achieve. An increase in opioid use can predispose patients to respiratory depression, pneumonia, and constipation with slow return of gastrointestinal function. Stopping narcotics preop, or even tapering use, can improve the patient’s postoperative period.
Successful surgical outcomes arise from a coordinated effort between the surgeon and the patient. Routine appointments and discussions with your primary care provider to optimize your medical conditions prior to surgery can decrease surgical risks or complications.