Risk Factors for Poor Outcomes

The newest JBJS ( The Journal of Bone and Joint Surgery) just arrived and as usual I started to look through the newest literature being published on the various Orthopedic specialities, in particular, Spine surgery as expected.

What better time during the holiday season to talk about risk factors for poor outcomes in cervical spine procedures and diabetes.

As you may be well aware, diabetes and smoking, are well known to be risk factors for poor outcomes related to any surgery.  Diabetes and smoking, namely nicotine, are considered a “microvascular ” disease that systemically effects the entire body rather than just the lungs or pancreas.

The best analogy that I can make related to how microvascular works in the body is through waterways.  Follow me on this, if you would take a large body of water such as a river, and as the river begins to work through it’s tributaries and smaller streams, eventually the river becomes a creek, the creek becomes a small stream, and so on and so on, until these small streams make their way to the farthest reaching plants and trees.  These small capillaries or micro-vasculature feeds these plants and streams with the water that they need.  If you cut off the water supply to these capillaries and streams, the plants and trees die.

The same be held true for the micro-vasculature of the body.  Diabetes and Smoking essentially chokes off the blood supply to the bone,  organs,  and tissues that need these pathways to survive.  If you block the blood supply to the bone, organs, and tissues, this in turn forces them to not work efficiently and effectively.

Essentially, working to better control diabetes, cease smoking, and losing weight all help to improve successful outcomes with any surgery.    Therefore, it is imperative to work with your medical provider to monitor your hemoglobin A1C, work on smoking cessation, and improve your overall health.

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1. References available