The Orthobullets Podcast Podiums⎪Spine⎪Spine Surgery Preoperative Optimization and Impact on Outcomes
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Feb 6, 2025 Dr. Ali Araghi, a leading expert in spine surgery preoperative optimization, shares valuable insights on improving surgical outcomes. He discusses the crucial role of tailored preoperative planning, particularly for patients with obesity, diabetes, and malnutrition. Araghi emphasizes the significance of nutrition and managing comorbidities, detailing how these factors can drastically influence recovery times. He also explores how preoperative factors like opioid usage and psychological health impact postoperative results, advocating for comprehensive assessments to enhance patient care.
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Obesity's Hidden Closure Tension
- Dr. Ali Araghi shared a case of an obese patient with a skinny back who had wound complications after spine surgery.
- A plastic surgeon explained the wound tension was caused by the large abdominal gravity pulling on the closure.
Diabetes and Malnutrition Impact Healing
- Diabetes impairs glucose use and oxygen delivery, causing ischemic tissues and poor healing.
- Malnutrition decreases fibroblast proliferation, collagen synthesis, and lymphocyte count, raising infection risk.
Use SGA for Malnutrition Assessment
- Use physical exams and subjective global assessment (SGA) scores to evaluate malnutrition preoperatively.
- Comprehensive tools like Aspen score help but are resource-intensive and not commonly used.