Pediatric Post-Operative Spinal Fusion Guidelines

Please see Scoliosis Protocol for therapy details

Rationale: Posterior spinal fusion is a major surgery in pediatric patients requiring vigilance perioperatively with intensive monitoring for cardiopulmonary and neurovascular compromise in the post-operative period.  In addition, timely interventions for pain and GI management are necessary, and pediatric patients with underlying neuromuscular disease are at increased risk for serious complications and prolonged hospitalization.

Background: Spinal fusion has a complex and critical postoperative course. Due to the nature of the surgery there is risk for multi -system complications.   The surgery may have associated significant blood loss with fluid shifts and general anesthesia exposure, at times, in excess of 6-8 hours.   Medical complications can include: respiratory depression, pneumothorax, failure to re-expand lung, blood loss and intravascular depletion, subsequent fluid overload with or without the syndrome of inappropriate antidiuretic hormone; urinary retention; functional ileus;, wound infection, and urinary tract infection.  Less commonly seen in children are cholelithiasis; SMA syndrome; pancreatitis and hepatitis; hemothorax; chylothorax; deep vein thrombosis/pulmonary embolism; and fat embolism.  Furthermore, pain can be significant and constipation is common and can further limit activity and progression of recovery.

Evidence Supports: Aggressive multimodal pain management including opiate use and adjunctive therapy including limited non-steroidal anti-inflammatory agents: incentive spirometry, and early mobilization; timely bowel management

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