Energy Consumption and Substrate Utilization During Spinal Surgery

Abstract

Introduction: This study aims to measure surgeon physiologic stress and energy expenditure during adult spine surgery. Energy expenditures were assessed based on patient BMI, lead use, instrumentation/intraoperative navigation, primary/revision surgeries, tranexamic acid (TXA) use, and anatomic region involved. Methods: The senior author wore a heart rate (HR) monitor and triaxial accelerometer during spinal surgeries, providing assessments of mean HR, maximum HR, calories consumed/minute, and calories as measured by a Polar device (P calories) and Fitbit device (F calories). Results: One hundred sixty-two surgeries were included. Median patient age was 62 years. Median BMI was 29.02. Significant differences existed for BMI and estimated blood loss (P < 0.05). TXA use had a significant effect on case time, estimated blood loss, P calories, F calories, and Kcal/min (P < 0.05). Instrumentation use was significant for all variables (P < 0.05), except for mean HR and Kcal/min (P > 0.05). Lead use did not have a significant effect on max HR, P calories, F calories, and Kcal/min (P > 0.05). Navigation use was associated with significant differences for every variable tested (P ≤ 0.05). Differences were observed between primary and revision surgeries for case time, estimated blood loss, and F calories (P < 0.05). Conclusions: In spinal surgery, the use of navigation, instrumentation use, TXA use, and performing revision surgeries were associated with increased energy expenditure and can potentially increase surgeon fatigue.