[Improve of surgical outcomes in spinal fusion surgery : evidence based peri- and intra-operative aspects to reduce complications and earlier recovery]. / Verbesserung des Operationsoutcomes in der Wirbelsäulenchirurgie : Evidenzbasierte peri- und intraoperative Aspekte zur Reduktion von Komplikationen und schnelleren Rekonvaleszenz.

OBJECTIVES: Because international data have a low level of evidence, a variety of treatment approaches for lumbar spine fusion operations are justified based on long-established or safety aspects. The aim of this work is to present an overview of evidence-based peri- and intraoperative treatment measures to shorten the recovery and increase patient satisfaction. MATERIALS AND METHODS: This review article is based on a selective literature search that also included PubMed on peri- and intraoperative treatment measures for lumbar spinal surgery. RESULTS AND DISCUSSION: Peri- and intraoperative treatment algorithms have a significant influence on postoperative recovery and patient outcome after lumbar spinal surgery. Recent studies show that intraoperative blood loss and blood transfusion can be significantly reduced by optimizing patient positioning and dorsoventral combined warming measures to maintain body temperature. These measures are supplemented by the use of local infiltration of anesthesia and vasoconstrictive drugs at the start and high-dose administration of tranexamic acid in the early stages of the operation. Use of an epidural catheter significantly reduces postoperative, systemic analgesia use and allows rapid mobilization to be initiated. Immobilizing drain and corset treatments can be limited to complex cases. These treatment measures promote patient satisfaction, lead to high-quality, evidence-based care, and contribute to a shorter hospital stay and convalescence of the patient.

[Pre- and postoperative fast-track treatment concepts in spinal surgery : patient information and patient cooperation]. / Prä- und postoperative Fast-track-Behandlungskonzepte in der Wirbelsäulenchirurgie : Patienteninformation und Patientenkooperation.

BACKGROUND: Evidence-based procedures and pathways to reduce peri- and postoperative complications, while simultaneously achieving a high satisfaction rate of patients and lower costs are important goals in the treatment of orthopedic patients. PURPOSE: This article describes the key factors to improve treatment of patients with indications for stabilization of one or two segments in the field of degenerative lumbar spine pathologies. A fast-track concept was developed to optimize the pathway of treatment, while increasing patient satisfaction and shortening the hospital stay. In the present patient cohort, significantly greater patient satisfaction and significantly shorter hospital stays were achieved. RESULTS: The hospital stay was reduced from 10.9 to 6.2 days after introduction of a multimodal patient school that was held 10 days prior to admission, with mobilization on the day of surgery with a strictly followed treatment plan supervised by therapists and taking into account the patient's own assessment, as well an early plan for discharge based on fixed established criteria. This concept is a very successful tool to achieve high quality standard of treatment paired with a reduction of hospital stay.