Neuromuscular Scoliosis Spinal Fusion — Orthopedic Evaluation, Consult Placement — Clinical Pathway

Neuromuscular Scoliosis Spinal Fusion Clinical Pathway — ICU, Inpatient, Outpatient Specialty Care

Preoperative Orthopedic Evaluation

The standard preoperative workup includes the following imaging, laboratory, nutrition evaluation, and patient teaching.

Once surgery is scheduled, each patient will be pre-assigned to an ARC NP for pre-anesthesia evaluation review.

Components of Orthopedic Preoperative Visit for All Patients
PICU Recovery
  • Schedule for PICU Recovery
    • Moderate to severe neuromuscular scoliosis and/or concomitant cardiac or respiratory disease
Imaging
  • Manual traction scoliosis X-rays in Orthopedic Clinic – positioned by surgeon
  • If obtained > 6 months before surgery, repeat:
    • X-ray AP/LAT Scoliosis:
      • Standing/weight bearing (preferred)
      • Seated
      • Supine
Laboratory Testing Preprocedural Standard Labs by Surgical Service
Nutrition Evaluation
  • Review CP Growth Chart:
    • Consult Nutrition if < 20th or > 90th percentile
  • Review baseline feeding:
    • Consult Nutrition for concerns
    • Consider pre-albumin level drawn by Nutrition/GI
  • Note:
    • If long time interval between the initial visit and the scheduled surgery date, review need for nutritional labs to be drawn after assessment
Patient Teaching
  • Give pre-operative surgical packet from surgeon's team
  • Consider bowel preparation at home with Polyethylene Glycol BID x3 days before surgery if appropriate. Provide instruction on contacting clinic if child experiences diarrhea.
  • Hydration recommended in patients who can tolerate increased fluids based on medical status:
    • Drink or via GT:
      • 32 oz of clear electrolyte sports drink or Pedialyte® the day before surgery
    • Drink or via GT:
      • 8 oz clear Pedialyte 3 hours before arrival at hospital