文档介绍：Crit Care Clin 19 (2003) 33–53
Critical care in orthopedic and spine surgery
Daniel Nazon, MDa,*, Glen Abergel, MDa,
Carlo M. Hatem, MDb
aDepartment of Critical Care Medicine, Montefiore Medical Center,
Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
bDepartment of Critical Care/Pulmonary Medicine, Montefiore Medical Center,
Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
Orthopedic and spine operations are being performed at an increased rate and
account for a significant part of the health care budget [1]. Familiarity with the
perioperative aspects of these procedures will help improve es, reduce the
length of stay (LOS) in the intensive care unit (ICU), and limit health care costs.
The need for ICU care can often be predicted based on patient’orbidities
and operative considerations. Unplanned admissions can also arise from prob-
lems that occur in the operative or recovery period. This article reviews those
aspects of critical care related to elective orthopedic and spine surgery.
Hip
An estimated 200,000 total hip replacement (THR) operations are performed
each year in the United Sates for management of painful arthritic hips [2]. Newer
anesthetic techniques, better perioperative care, and improved prophylaxis for
deep vein thrombosis (DVT) have contributed to a threefold decrease in
morbidity and mortality.
Preoperative considerations
Data from a National Institutes of Health (NIH) survey estimate the overall
risk of death after THR to be less than 1% [3]. The most important determinant
of mortality is age. Patients between 66 and 69 years of age have a perioperative
mortality of %, compared with % in the age group above 85 years.
Women usually have a lower mortality rate. Total hip replacement for hip fracture
* Corresponding author.
E-mail address: dnazon@ (D. Nazon).
0749-0704/03/$ – see front matter D 2003, Elsevier Science (USA). All rights r