Inpatient Clinical Pathway for Neuromuscular Scoliosis Post-Op Management of Spinal Fusion
Complications
- ICU
- Respiratory insufficiency
- Blood loss/coagulopathy
- Lactic acidosis
- SIRS response
- Neurogenic shock
- Ileus
- Inpatient
- Increased respiratory requirements
- Incisional drainage
- Ileus
- Persistent fever > 72 hours
- Urinary retention
- Seroma
Initial Orthopedic Clinic Visit –
Surgical Considerations for Providers and Risk Stratification
Surgical Considerations for Providers and Risk Stratification
Preoperative Evaluation (Main or ASCs)
Admit Postop
All Patients: Standard Postoperative Management
Pain Management
Tubes & Drains
Nutrition
Infectious Disease
Consultations
Pain Management
Tubes & Drains
Nutrition
Infectious Disease
Consultations
Moderate – Consider ICU Admission
High risk – PICU
Patient characteristics:High risk – PICU
- Preop: Baseline trach/vent, CPAP/BiPAP, cardiac dysfunction
- Intraop: Spinal shock, blood loss > 1 blood volume, ongoing hypotension
ICU Goals
IV analgesia
CV stability
Pulmonary toilet
Advance mobility
IV analgesia
CV stability
Pulmonary toilet
Advance mobility
PICU Transfer Out Criteria
Extubated
Adequate analgesia
Arterial line removed
Hemodynamically stable
Extubated
Adequate analgesia
Arterial line removed
Hemodynamically stable
Low Risk – 4E/4S Surgical Unit or 8 South
Patient characteristics:- Preop: Ambulatory, minimal pulmonary disease
- Intraop: Curve < 80 degrees
Inpatient Goals
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Transfer to Surgical/Specialty
(Pulmonary/PCU/4E/4S as appropriate)
(Pulmonary/PCU/4E/4S as appropriate)
Inpatient Goals
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Posted: May 2016
Revised: April 2020
Authors: K. Baldwin, E. Stegonshek, T. Muhly, K. Ryan, D. Singh, H. Wolfe, P. Konen
Revised: April 2020
Authors: K. Baldwin, E. Stegonshek, T. Muhly, K. Ryan, D. Singh, H. Wolfe, P. Konen
Evidence
- Patient Population Information
- Releasing the tether: Weight normalization following corrective spinal fusion in cerebral palsy
- Surgeon and Caregiver Agreement on the Goals and Indications for Scoliosis Surgery in Children with Cerebral Palsy
- Do All Patients With Cerebral Palsy Require Postoperative Intensive Care Admission After Spinal Fusion?
- Improving Health-related Quality of Life for Patients With Nonambulatory Cerebral Palsy: Who Stands to Gain From Scoliosis Surgery?