|
| | 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 |
|
