are aware of the risks of a dural tear before surgery and remind them
at discharge to call their surgeon if they develop nausea, sensitivity to
light and/or a severe positional headache while recovering at home.
4. Take precautions against SSIs
While studies have found that outpatient spinal procedures actually
have a lower risk of infection compared to inpatient ones, you still
must take precautions to avoid SSIs in your patients.
Typically with our spinal patients, we have them do a 4%
chlorhexidine gluconate (CHG) scrub the night before and on the
day of surgery. Your patients should receive clear pre-op instruc-
tions on how to use the scrub, and you may even consider provid-
ing the solution to them to ensure the protocol is followed. Then,
on the day of surgery, patients are given prophylactic antibiotics.
This is typically sufficient for our outpatient cases, and they don't
require follow-up antibiotics.
Technique also plays a role in your infection control efforts. Open
procedures have been clinically shown to have higher rates of SSIs
compared to newer minimally invasive techniques, and studies show
that the longer the procedure, the higher the chance of infection.
Patients who smoke, or who use steroids, or who have diabetes, high
BMI or are malnourished, are also at increased risk of infection; care-
fully monitor these patients.
Additionally, while inpatients have around-the-clock nursing in the
days after spinal surgery, you must have other monitoring methods in
place for your outpatients. Consider teaming up with a local nursing
group to start a home recovery program, where a nurse can visit the
patient a day or two after surgery and check for infections. This is
especially important for your patients undergoing more-complex
cases, like lumbar spinal fusions.
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