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One‐Stage Versus Two‐Stage Anterior and Posterior Spinal Reconstruction in Adults Comparison of Outcomes Including Nutritional Status, Complication Rates, Hospital Costs, and Other Factors

Twenty-four patients undergoing anterior and posterior spinal fusion were preoperatively assessed and at weekly intervals during their hospitalization for the following: serum albumin, transferrin, total lymphocyte count, skin anergy and anthropometric measurements. Eleven patients underwant staged anterior and posterior spinal reconstruction and 13 patients underwent similar procedures in a combined fashion. The groups were similar in age, sex, diagnosis, and number of levels fused. Results of these tests were kept as well as operative time, blood loss, transfusion requirements, wound healing problems, infection, length of hospital stay, patient satisfaction, and total cost. All 24 patients had normal preoperative nutritional parameters. Seven patients in the staged group and ten in the combined group became malnourished after surgery. No patient in the combined group developed infection or a wound healing problem. Wound infections developed in two of the seven patients in the staged group after their second procedure. The average number of units of blood transfused and the operating time were similar for both groups. The average length of hospital stay for the staged group was 20 days compared to 13 days for the combined group. Total hospital bills averaged 30% less in the combined group. All patients stated that they preferred to have the procedures done under the same anesthetic. The authors conclude that protein and calorie malnutrition develops to an appreciable extent in adults undergoing anterior and posterior spinal reconstructive procedures. It therefore increases the postoperative morbidity if staged surgical procedures are performed too close together as is currently done by many spine surgeons. Wound and other infections are the most closely related problems associated with postoperative protein mainutrition. Fewer infections complications might therefore result if the surgical procedures can be performed under one anesthetic, as reported in this study. In addition, the combined approach is advantageous for patient satisfaction and economic consderations.