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Perioperative Management: Surgical Site Infection Prevention, DVT Prophylaxis, and Blood Loss Management

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Surgery of the Cranio-Vertebral Junction

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Abstract

The success of a spine surgical procedure relies on a multidisciplinary teamwork with the need to follow specific guidelines. Antibiotic and deep vein thrombosis/pulmonary embolism prophylaxis is a crucial part of the surgical strategy. The infringement of guidelines may lead to major complications. Furthermore, management of blood loss during the surgical procedure is fundamental.

There is grade B evidence that a single preoperative dose of antibiotic may decrease infection rates in patients undergoing simple spine surgical procedures.

Deep vein thrombosis and subsequent pulmonary embolus can occur following spinal surgery, which leads to increased morbidity and mortality. Prevention by using compression stockings, mechanical devices, or chemoprophylaxis medication is recommended. Objective diagnostic methods, such as venography or Doppler ultrasounds, should be used to confirm a suspected DVT in postoperative spine patients.

The presence of a well-developed perivertebral venous plexus at the craniovertebral junction can expose surgeons to troublesome intraoperative bleeding. Extensive blood loss may rarely lead to greater transfusion needs, hemodynamic instability, and devastating neurological damage because of the vicinity of major and highly fragile neurological structures such as the spinal cord. Use of intraoperative and postoperative strategies may be able to reduce excessive bleeding.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

    Granit Molliqaj

  2. Department of Anesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland

    Matthias Robin, Christoph Czarnetzki & Marie-Josée Daly

  3. Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals, Geneva, Switzerland

    Americo Agostinho

  4. Neurosurgical Unit, Geneva University Hospitals, Geneva, Switzerland

    Enrico Tessitore

Authors
  1. Granit Molliqaj
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  2. Matthias Robin
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  3. Christoph Czarnetzki
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  4. Marie-Josée Daly
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  5. Americo Agostinho
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  6. Enrico Tessitore
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Corresponding author

Correspondence to Enrico Tessitore .

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Editors and Affiliations

  1. Neurosurgical Unit, Geneva University Hospitals, Geneva, Switzerland

    Enrico Tessitore

  2. Department of Neurosurgery, North Shore University Hospitals, Manhasset, NY, USA

    Amir R. Dehdashti

  3. Neurosurgical Unit, ASL Napoli 2 Nord, Naples, Italy

    Claudio Schonauer

  4. Department of Neurosurgery, Innsbruck University Hospitals, Innsbruck, Austria

    Claudius Thomé

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Molliqaj, G., Robin, M., Czarnetzki, C., Daly, MJ., Agostinho, A., Tessitore, E. (2020). Perioperative Management: Surgical Site Infection Prevention, DVT Prophylaxis, and Blood Loss Management. In: Tessitore, E., Dehdashti, A., Schonauer, C., Thomé, C. (eds) Surgery of the Cranio-Vertebral Junction. Springer, Cham. https://doi.org/10.1007/978-3-030-18700-2_8

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