Development and implementation of a comprehensive spine surgery enhanced recovery after surgery protocol: the Cleveland Clinic experience.

Enhanced recovery after surgery (ERAS) protocols have been shown to be effective at reducing perioperative morbidity and costs while improving outcomes. To date, spine surgery protocols have been limited in scope, focusing only on specific types of procedures or specific parts of the surgical episode. The authors describe the creation and implementation of one of the first comprehensive ERAS protocols for spine surgery. The protocol is unique in that it has a comprehensive perioperative paradigm encompassing the entire surgical period that is tailored based on the complexity of each individual spine patient.

Considerations for Appropriateness of Virtual Learning in the Postpandemic Environment.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, health professions educators who traditionally used a face-to-face mode to deliver education transitioned to virtual formats. With the widespread use of vaccines, restrictions on social distancing requirements have waned. Some educators have reverted to a face-to-face modality, whereas others have maintained a virtual modality. METHOD: A framework was developed to evaluate the suitability of curricular elements to be presented in a virtual platform to guide educators in modality decision making. RESULTS: Learner motivation, context and content compatibility, social learning community requirements, and technological infrastructure should be considered when planning future curricula delivery. CONCLUSION: The virtual learning environment must be compatible with content and context. Appropriate technology infrastructure, which includes institutional support, virtual learning platform, and technological support, also must be in place. Hybrid modalities that divide content into face-to-face and virtual components can be used to ease demands on logistics and technology infrastructure limitations. [J Nurs Educ. 2022;61(9):503-509.].

Enhanced Recovery in Spine Surgery and Perioperative Pain Management.

Enhanced recovery after surgery is an interdisciplinary, multimodal approach to improve postoperative outcomes by applying multiple evidenced-based interventions. It has been adapted at multiple institutions for patients undergoing spine surgery to combat the rising rate of opioid consumption. Various preoperative, intraoperative, and postoperative pharmacologic and nonpharmacologic interventions have been introduced to augment patient care with the goal to decrease hospital length of stay and improve postoperative outcomes. Future studies will focus on health care-related quality of life outcomes to evaluate the effectiveness of enhanced recovery after surgery across various benchmarks.

Perioperative visual loss after spine surgery.

Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effective treatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy.