Preoperative optimization of adult patients undergoing surgery for scoliosis, kyphosis, or spinal deformity is one of the most important — and often underappreciated — factors in achieving good surgical outcomes. Patients who present for major spinal deformity surgery with suboptimal bone density, nutritional deficiencies, poorly controlled diabetes, or other modifiable risk factors have measurably higher rates of complications, hardware failure, and prolonged recovery than those who have been appropriately optimized before surgery.
Our recent systematic review, published in Spine (March 2024), provides a practical, evidence-based framework for physicians managing patients in the preoperative period ahead of adult spinal deformity surgery.
Key Modifiable Risk Factors
The review identifies and synthesizes the evidence on the following modifiable risk domains:
- Osteoporosis — bone quality directly affects pedicle screw purchase and fusion rates; medical treatment before elective deformity surgery is strongly supported by the evidence
- Malnutrition — albumin and prealbumin levels predict wound healing and infection risk; nutritional supplementation should be initiated early in the preoperative period
- Diabetes and glycemic control — HbA1c levels above 7.5–8% are associated with significantly higher surgical site infection rates and impaired fusion
- Frailty — validated frailty indices predict major complication risk and should inform patient selection and timing for major deformity surgery
- Tobacco use — smoking is associated with pseudarthrosis; smoking cessation before surgery meaningfully improves fusion rates
The central finding of the review is that systematic, proactive optimization across these domains — ideally coordinated through a multidisciplinary preoperative clinic — can meaningfully reduce complications and improve long-term outcomes in adult spinal deformity surgery.
Full citation: Katiyar P, Reyes J, Coury J, Lombardi J, Sardar Z. Preoperative Optimization for Adult Spinal Deformity Surgery: A Systematic Review. Spine. 49(5):304-312, 2024.
About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University. He co-authored this systematic review and leads a multidisciplinary preoperative optimization program for complex spinal deformity patients. To schedule a consultation, call 212-932-5187 or visit the contact page.
This post is for educational purposes only and does not constitute individualized medical advice.