Electrolyte Disturbances and Repletion in Orthopaedic and Spine Surgery Patients.

Electrolyte derangement, defined as disorders of clinically impactful physiologic ions such as potassium, sodium, calcium, magnesium, and phosphate, has a variety of clinical manifestations. These electrolytes have narrow windows of normal in vivo concentration before neurologic, cardiac, renal, or gastrointestinal consequences occur. Perioperative disturbances in electrolyte concentration can lead to increased morbidity and mortality, longer length of stay, and higher rates of short and medium-term readmission in orthopaedic and spine surgery postoperatively. To prevent electrolyte related complications, careful monitoring and repletion of at-risk patients must be undertaken. A systematic approach to repletion allows for a safe and efficacious treatment of these disorders.

Preoperative Resilience and Improvement in Patient-Reported Outcomes After Lumbar Spinal Fusion.

BACKGROUND: It is incompletely understood how preoperative resilience affects 1-year postoperative outcomes after lumbar spinal fusion. METHODS: Patients undergoing open lumbar spinal fusion at a single-center institution were identified between November 2019 and September 2022. Preoperative resilience was assessed using the Brief Resilience Scale. Demographic data at baseline including age, gender, comorbidities, and body mass index (BMI) were extracted. Patient-reported outcome measures including Oswestry Disability Index, PROMIS (Patient-Reported Outcomes Measurement Information System) Global Physical Health, PROMIS Global Mental Health (GMH), and EuroQol5 scores were collected before the surgery and at 3 months and 1 year postoperatively. Bivariate correlation was conducted between Brief Resilience Scale scores and outcome measures at 3 months and 1 year postoperatively. RESULTS: Ninety-three patients had baseline and 1 year outcome data. Compared with patients with high resilience, patients in the low-resilience group had a higher percentage of females (69.4% vs. 43.9%; P = 0.02), a higher BMI (32.7 vs. 30.1; P = 0.03), and lower preoperative Global Physical Health (35.8 vs. 38.9; P = 0.045), GMH (42.2 vs. 49.2; P < 0.001), and EuroQol scores (0.56 vs. 0.61; P = 0.01). At 3 months postoperatively, resilience was moderately correlated with GMH (r = 0.39) and EuroQol (r = 0.32). Similarly, at 1 year postoperatively, resilience was moderately correlated with GMH (r = 0.33) and EuroQol (r = 0.34). Comparable results were seen in multivariable regression analysis controlling for age, gender, number of levels fused, BMI, Charlson Comorbidity Index, procedure, anxiety/depression, and complications. CONCLUSIONS: Low preoperative resilience can negatively affect patient-reported outcomes 1 year after lumbar spinal fusion. Resiliency is a potentially modifiable risk factor, and surgeons should consider targeted interventions for at-risk patient groups.