Peri-operative optimization in adult spinal deformity surgery

The population aged 65 and over is projected to double by the year 2050. As the population continues to age, the incidence of adult spinal deformity (ASD) will continue to rise. It is estimated that 30–50% of patients older than 65-years develop a degenerative scoliosis. Many of these patients have little to no symptoms as a result of their deformity and continue to lead active and healthy lives. A smaller subset of patients with degenerative scoliosis develops pain and disability as a result of their underlying deformity. The outcomes of surgery in this group are generally favorable but there is significant risk and potential morbidity associated with deformity correction surgery. The pre-operative planning and technical aspects of surgery are important but the peri-operative optimization of modifiable factors to minimize the risk of complications is even more important to achieve optimal outcomes. This paper will review the most up-to-date literature on the peri-operative optimization of patients undergoing adult spinal deformity surgery.