Working Together To Improve Outcomes For Spinal Surgery Patients With Cardiac Risk Factors
The heart and spine may play different roles in keeping the body functioning properly, but that doesn’t mean there isn’t some overlap when health challenges occur.
It turns out that approximately 40 per cent of patients requiring spinal surgery also have cardiac risk factors.
Rather than treat each issue solely on its own, a group of doctors and researchers have partnered to help these patients achieve the best possible outcomes by increasing their mobility, knowledge and cardiovascular health before surgery.
They are part of a research project called Elucidating the effects of a prehabilitation program on spinal surgery candidates with cardiac comorbidities outcomes: A randomized, controlled trial.
“The doctors involved with this project discussed the large overlap between orthopaedic spine and cardiac patients and partnered to integrate their care, utilizing the existing New Brunswick Heart Centre’s infrastructure to try and improve these patient’s outcomes across the board,” said Erin Bigney, Head of Research with the Canada East Spine Centre.
The project involves a randomized, controlled trial of surgical spine patients that are at risk for cardiac issues. The participants are using the cardiac rehabilitation program in advance of spine surgery, to see if it improves mental health, decreases disability and pain, and reduces cardiac risk factors before surgery and six months after surgery.
“We are also hoping this project will help reduce adverse events, opioid use, and length of hospital stay,” said Bigney. “The proposed study has the potential to improve postoperative patient outcomes and maximize their long-term overall health.”
The current research team is a collaboration with cardiologist Dr. Robert Stevenson and physiotherapist Stephen Mundle at The New Brunswick Heart Centre’s cardiovascular health and wellness program, specifically with the Saint John Regional Hospital’s cardiac rehabilitation program, and Saint John orthopaedic surgeons Dr. Edward Abraham and Dr. Neil Manson. The Canada East Spine Centre research team includes Bigney, Eden Richardson, Dana El-Mughayyar, Mariah Darling and Amanda Vandewint.
“Providing integrated care through collaboration between orthopaedics and cardiology not only allows patients to be seen by a cardiologist for their risk factors before they result in a health crisis, it creates an opportunity to improve the patient’s overall health prior to surgery,” said Dr. Abraham, noting that this project achieves this through programing that comes at no cost to the patient and no additional cost to the health-care system.
Mundle has been involved with the cardiac rehabilitation program since it began in 1995 and said he has seen a number of benefits to the patients who have used it, including increased activity and fitness levels, improved risk factor profiles, and better medication compliance.
So far, he said, integrating the spine patients into the program has been relatively seamless as they would qualify as patients at risk.
“The main challenge is determining which mode of exercise will benefit them without exacerbating their spine issues,” he said.
The cardiac rehabilitation program is available throughout the province through the Horizon Health Network. The main centre participating in this research project is Saint John Regional Hospital, but other participating locations include Hôtel-Dieu Saint-Joseph de Saint-Quentin, The Moncton Hospital, Chaleur Regional Hospital and Edmundston Regional Hospital.
“We are currently recruiting patients for the project. If the program has the expected results and benefits to patients, the next step would be launching this project provincially,” said Bigney. “This will be easy as the New Brunswick Heart Centre’s cardiac rehabilitation program is already a provincial program with the entire necessary infrastructure in place.”
The project began recruitment in December 2018 and is expected to be completed in March 2021. It is funded through generous donations to the Saint John Regional Hospital Foundation, including a significant donation from The McCain Family Foundation.
“We are lucky here in New Brunswick to have excellent supports for surgeons to conduct research from institutions like the New Brunswick Health Research Foundation and the Saint John Regional Hospital Foundation,” said Dr. Abraham. “They provide various supports and help make large scale quality projects like the current one possible.
This story is sponsored by the New Brunswick Health Research Foundation (NBHRF).
Check out the photo gallery of the research team below: