Chronic diseases complicate spine or joint surgery

By Chung Hung-tae

Changes in lifestyle and the aging of society are resulting in an increasing number of people suffering from spine and joint disorders. The numbers of spine surgeries and joint surgeries increased by 67 percent and 66 percent respectively over the past five years, to mark 150,000 and 50,000 cases in 2011. Worse still, these people probably have multiple health problems. According to data by Korea Institute for Health and Social Affairs, patients of any chronic disease, aged 65 or older, have 3.45 chronic diseases on average.

Hence, more emphasis is being put on “total care” for patients who have spine or joint problems accompanied by chronic disease, to manage not only the spine or joint problem but also the accompanying diseases.

In particular, it is risky to perform such surgery without considering the condition of the patient because an emergency situation can occur during an operation. For instance, a clinical report shows that the risk of infection is 3.2 times higher when a diabetic undergoes a spine surgery compared with the normal blood sugar group.

It takes extra caution for the surgery as there can be an aggravation of diseases, or delays in recovery of the surgical site due to the impediment of thrombopoiesis and changes in the body fluid volume and electrolytes besides infection.

According to a 2012 analysis on spine or joint disorder patients aged 40 or older at Bumin Hospital, one in three patients had a chronic accompanying disease. The most common was hypertension, suffered by 60.3 percent, followed by diabetes at 33.3 percent, hyperlipidemia at 3.5 percent, and cardiovascular disease at 2.8 percent.

Two out of three such patients were women. Women are more vulnerable to such multiple problems as despite increasing cases of spine, joint and chronic diseases following increasing social activities and domestic labor, they tend not to visit the hospital until their condition seriously aggravates.

It also increased with age. The survey shows that the ratio of patients with chronic accompanying diseases greatly increases to 38 percent among those in their 60s and 50 percent in their 70s, from only 5 percent among those in their 40s. Among those aged 80 or older, 82 percent were accompanied by chronic disease. The increase shows that elderly spine or joint patients should be managed along with their chronic diseases.

In particular, it is utmost important to accurately understand the patient’s condition as there are various treatment modalities and diverse symptoms depending on the patient with spine or joint disorders. One should be extremely cautious in deciding a surgery, taking into account extensive factors such as the progress of an accompanying disease, dose of a drug in administration, blood sugar level, blood pressure and body temperature, and stamina.

As our human body is organically connected, spine and joint disorders and a chronic disease can mutually affect one another even though they might appear to be unconnected. Even for a stable patient, it is better to be treated at a hospital equipped with the total care system that allows an accurate diagnosis on the patient’s condition and management of several diseases since an emergency could occur abruptly from other chronic diseases during the treatment.

However, it doesn’t mean that a surgery is impossible for elderly patients with spine and joint disorders along with chronic disease. With thorough preparation for the possible emergency after accurate understanding of the patient’s condition, elderly patients can get surgeries.

“Minimally Invasive Surgery,” a surgical method allowing close examination of the surgical site through a microscope, has been in the spotlight recently for these patients. It has been noted for efficacy and safety since it leaves a very tiny scar compared to the previous surgery.

In addition, it is less painful and enables the patients to be on their feet faster after the surgery, and the hospitalization period is reduced because of fast recovery. Especially, as no transfusion is required, there is no risk of a transfusion accident, and it thus has better prognosis for the patients with internal diseases such as diabetes, and for the elderly patients.

The writer is the chairman of Bumin Hospital.