Guidelines For Patients

Guidelines for Patients

What are the steps to follow before surgery?
Most patients who undergo spinal surgery have weeks or months to prepare for their procedure. It's important to learn as much as you can about your spine surgery. In this article, you will learn about the pre-operative steps to help you prepare for your procedure.

Importance of Preoperative Evaluation
Surgical procedures of any type carry varying amounts of risk. A surgical risk assessment combines this risk percentage with the patient’s physical and emotional health. During the preoperative evaluation, facts about the patient’s health (eg, pre-existing conditions such as diabetes) are investigated enabling medical staff to take pro-active steps to reduce surgical risk.

This evaluation includes an in-depth review of the patient’s medical history, findings from x-rays, CT scans, MRI studies, and/or other diagnostic tests. The patient’s general health is reviewed during a physical and neurological examination.

The preoperative evaluation identifies physical conditions (existing and unknown) that could cause surgical complications (eg, cardiac or breathing difficulties). In some cases, the patient may be referred to a medical specialist for consultation prior to surgery.

Pre-operative Goals
The pre-operative evaluation helps the medical staff provide the patient with the correct amount of:
•    anesthesia
•    pre-operative medical treatment
•    monitoring during surgery
•    post-operative pain management and care.
The pre-operative process also provides opportunities for the patient, primary care physician, treating specialists, surgeon, and anesthesiologist to communicate concerns before and after surgery.
Medical History and Examination
A detailed medical history gathers information about allergies (eg, to medication, food, allergens), side effects from medication, medication and/or dietary supplements taken daily, pre-existing medical conditions, family history, tobacco and alcohol use, bleeding history and previous surgical experiences (eg, problems with anesthesia).
Any condition affecting the cardiovascular, pulmonary, gastrointestinal, endocrine, and nervous systems can increase surgical risk. Understanding these problems and addressing them before and during surgery can make the spinal procedure safer.

Pre-operative Tests

A small blood sample can provide a wealth of information about the patient’s general health. A low red blood cell count (hemoglobin) may indicate the presence of anemia. Red blood cells are needed to carry oxygen throughout the body. White blood cells (WBC) are needed to fight infection. Platelets are the smallest cells in the blood and are essential to blood coagulation. A partial thromboplastin time (PTT) test reveals clot formation time. The level of glucose (sugar) in the blood (blood glucose level) is helpful in determining if the patient has diabetes or is hypoglycemic (low blood sugar).

Electrolytes are needed for metabolic function. For example, calcium is necessary for contraction of skeletal muscle as well as relaxation of cardiac muscle. Blood urea nitrogen (BUN) indicates metabolic function of the liver and kidney efficiency.

A urinalysis detects urinary tract infection, kidney function, diabetes, and the body’s state of hydration/dehydration.
Male patients over age 50 and female patients over age 60 may be given a preoperative electrocardiogram (EKG),2D Echo, Venous Doppler and Dexa Scan. Patients with a history of cardiovascular surgery, angina, diabetes, peripheral vascular disease, or smokers are usually EKG candidates, whatever their age. These same patients may also be ask for  chest x-ray  separately or together. During this consultation, you and your surgeon and/or anesthesiologist will review your medical records, the benefits of the proposed surgery, type of anesthesia, the surgical procedure(s), potential risks and complications, pain management, pre- and post-hospitalization, rehabilitation, and recovery.

The surgical and anesthesiology plan is put into writing in a document termed a Consent Form. By signing this document, the patient gives their permission to the surgeon and/or anesthesiologist to perform procedure(s). The surgical and anesthesiology Consent Forms may be separate documents.