Spine Surgery: A Clinical Practice Guideline for Perioperative Nursing Care (Guideline & Webinar)-AANN24_Spine CPG

AANN24_Spine CPG_Final

Pdf Summary

The American Association of Neuroscience Nurses’ 2024 guideline synthesizes evidence on perioperative nursing care for adults undergoing spine surgery. It addresses 14 clinical questions across preoperative, intraoperative, and postoperative care. The authors searched multiple databases for English-language studies published from 2011 to February 2022, assessed study quality using GRADE, and included varied research designs because nursing-specific evidence was limited.

Key recommendations include:

- <strong>Before surgery:</strong> Provide patient education to reduce anxiety and support recovery; assess and address risks such as poor glycemic control, smoking, stress, and delirium. Exercise-based prehabilitation may improve function and shorten hospitalization. Use infection-prevention bundles; evidence for nasal MRSA screening and VTE prophylaxis is weaker.
- <strong>During surgery:</strong> Allow povidone-iodine to dry before incision, consider silicone foam dressings at pressure points for prone patients, and use active warming to reduce hypothermia and shivering. Evidence comparing common skin-preparation solutions is inconclusive.
- <strong>After surgery:</strong> Use visible occlusive dressings alongside infection-prevention measures. Enhanced recovery after surgery (ERAS) approaches—including early nutrition, appropriate drain management, and early mobilization—may improve recovery and reduce complications or length of stay. Assess urinary-retention risks and use protocols for catheter management and ambulation. For pain, multimodal, nonopioid strategies—including gabapentin or pregabalin—can reduce pain and opioid use.
- <strong>For spinal cord injury:</strong> Individual or group support may improve patient self-efficacy. Bowel and bladder management, and nursing protocols to prevent autonomic hyperreflexia, are also recommended, though evidence quality varies.

The strength of evidence ranges from very low to high, and several recommendations rely on studies of bundled interventions, making individual effects difficult to isolate. The guideline is intended as practice guidance, not a guarantee of outcomes; it also highlights the need for more research on nursing interventions.

Keywords

spine surgery

perioperative nursing

preoperative care

intraoperative care

postoperative recovery

infection prevention

prehabilitation

ERAS

pain management

spinal cord injury