|
| Perioperative risks | Action |
|
Cystic fibrosis | Poor pulmonary reserve/restrictive lung disease | (1) Preoperative chest physiotherapy and increase in exercise |
(2) Noninvasive ventilation, chest physiotherapy, early mobilisation postoperatively |
Recurrent infections | (1) Perioperative antibiotics |
Poor nutrition | (1) Emphasis on adequate oral diet |
(2) Nutritional supplements |
Poor bone quality | (1) Bisphosphonate treatment |
|
Major surgical insult | Increased intraoperative blood loss | (1) Hypotensive anaesthesia |
(2) Local haemostats used |
(3) Meticulous, sequential spinal exposure |
(4) Use of less implants |
(5) Use of cell saver |
(6) Use of allograft (no need for harvesting autologous bone from other sites) |
Reducing surgical time | (1) Use of single rod construct |
Pain effect on | (1) Limited use of IV opioids |
(i) chest, | (2) Aggressive chest physiotherapy |
(ii) mobilisation, | (3) Early postoperative mobilisation |
(iii) gastrointestinal system | (4) Supportive GI medication (including antiemetics and laxatives) |
|
Scoliosis correction | Neurological | (1) Use of a single rod construct (less implant density) |
Infection | (1) Use of a single rod construct |
(2) Prophylactic antibiotics |
Respiratory compromise | (1) Thoracoplasty not performed |
Nonunion | (1) Extensive bone grafting |
(2) Postoperative support with spinal jacket |
Superior mesenteric artery syndrome | (1) Early instigation of oral diet |
(2) Nutritional supplements before and after surgery |
(3) Early postoperative mobilisation |
|