Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Abstract

Evidence-based standardization of the perioperative management of patients undergoing complex spine surgery can improve outcomes such as enhanced patient satisfaction, reduced intensive care and hospital length of stay, and reduced costs. The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) tasked an expert group to review existing evidence and generate recommendations for the perioperative management of patients undergoing complex spine surgery, defined as surgery on 2 or more thoracic and/or lumbar spine levels. Institutional clinical management protocols can be constructed based on the elements included in these clinical practice guidelines, and the evidence presented.

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022

“…[59][60][61] Finally, there are the recent clinical practice guidelines from the Society for Neuroscience in Anesthesiology and Critical Care on Perioperative care of patients undergoing major complex spinal instrumentation surgery, and the guideline from the American Heart Association/American Stroke Association on the management of patients with spontaneous intracerebral hemorrhage. 62,63…”

“…62,63 Ma J, Bi Y, Zhang Y, et al Erector spinae plane block for postoperative analgesia in spine surgery: a systematic review and metaanalysis. Eur Spine J 2021;30(11):3137-3149 10 Oh SK, Lim BG, Won YJ, Lee DK, Kim SS.…”

Value-based Care and Quality Improvement in Perioperative Neuroscience

“…Process mapping and dashboards are examples of tools that have been successfully applied to value-based neurosurgical care to design solutions and continuously evaluate outcomes, respectively 24,25. Though current evidence supports improved outcomes with ERAS programs in spine surgery, including a reduction in complications, length of stay, and improved postoperative pain management,26 the Society for Neuroscience in Anesthesiology and Critical Care guidelines for major complex spine surgery27 noted variability in the current literature in the components relevant to anesthesia. Recent systematic reviews have also highlighted limited evidence on best practice 28.…”

Guidelines for Major Spinal Instrumentation Surgery: Comment to the Editor

“…The recent clinical practice guidelines on the perioperative care of patients undergoing major complex spine instrumentation surgery are a useful, succinct summary. 1 As noted by the authors, heterogeneity of the studies and limited prospective evidence to support several recommendations (especially related to analgesia) require future multi-institutional research initiatives. Given the prescient risk of significant bleeding during major spinal instrumentation surgery, we are surprised to see no comment on monitoring for major bleeding in the transfusion management section.…”