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Energy Consumption and Substrate Utilization During Spinal Surgery.

Samuel Zonshayn1, Christina Coppola, James P Lawrence

  • 1From the Department Orthopedic Surgery, Albany Medical Center, Albany, NY (Dr. Zonshayn, Ms. Coppola); Department of Orthopedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr. Lawrence).

Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews
|February 14, 2024
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Summary
This summary is machine-generated.

Surgeon physiologic stress and energy expenditure in spine surgery increase with navigation, instrumentation, tranexamic acid (TXA) use, and revision procedures, potentially leading to fatigue.

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Surgical Technology

Background:

  • Measuring surgeon physiologic stress and energy expenditure during adult spine surgery is crucial for understanding operative demands.
  • Factors influencing energy expenditure include patient BMI, lead use, instrumentation, intraoperative navigation, primary/revision status, tranexamic acid (TXA) use, and surgical region.

Purpose of the Study:

  • To quantify surgeon physiologic stress and energy expenditure during adult spine surgery.
  • To identify surgical variables associated with increased energy expenditure and potential surgeon fatigue.

Main Methods:

  • The senior author wore a heart rate monitor and accelerometer during 162 adult spine surgeries.
  • Physiologic data collected included mean and maximum heart rate (HR), and calorie expenditure measured by Polar (P calories) and Fitbit (F calories) devices.
  • Surgical variables analyzed included patient BMI, lead use, instrumentation, intraoperative navigation, TXA use, and primary/revision status.

Main Results:

  • Navigation use significantly impacted all measured variables (P ≤ 0.05).
  • Instrumentation use, TXA use, and revision surgeries were associated with significant differences in energy expenditure and other key metrics (P < 0.05).
  • Patient BMI and estimated blood loss also showed significant differences (P < 0.05).

Conclusions:

  • Spine surgery techniques such as navigation, instrumentation, TXA administration, and performing revision procedures are linked to heightened surgeon energy expenditure.
  • These factors may contribute to increased surgeon fatigue, highlighting the need for strategies to mitigate operative stress.