271 - Risk Factors for Pneumonia following Cervical Spine Surgery...

#271 Risk Factors for Pneumonia following Cervical Spine Surgery

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Postoperative pneumonia is a potentially life-threatening complication of any surgical procedure. The incidence as well as the risk factors for pneumonia following cervical spine surgery are scarcely reported. We utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify preoperative and intraoperative risk factors following cervical spine surgery (CSS).

Methods: The ACS NSQIP database was queried to identify patients undergoing elective CSS for degenerative diagnoses between 2006 and 2011. Patients with trauma, infection, tumor, and deformity diagnoses were excluded. Patients who were diagnosed with a postoperative pneumonia were compared to unaffected patients. Preoperative patient health characteristics, preoperative laboratory values, surgery and hospital outcomes (operative time, length of stay (LOS), readmission and reoperation rates, and mortality) were compared between groups. SPSS v.20 was utilized for statistical analysis with independent t-tests and χ2-tests for continuous and categorical variables respectively. Multivariate regression analysis demonstrated the independent risk factors for postoperative pneumonia following a CSS. A p-value ≤ 0.05 denoted statistical significance.

Results: A total of 8,648 cervical spine surgeries were identified from 2006-2011. There were 59 (0.7%) patients who developed postoperative pneumonia. Patient with postoperative pneumonia demonstrated a greater number of comorbidities including diabetes, COPD, hypertension, ESRD, preoperative paralysis, and recent operation within 30 days (p < 0.05). Preoperative lab values that were associated with postoperative pneumonia included a decreased hematocrit and albumin, and an increased creatinine (p < 0.05). Patients who developed postoperative pneumonia demonstrated greater ASA scores (class 3 and 4), operative time and blood transfusions. In addition, the affected patients demonstrated a greater LOS, readmissions/reoperations, unplanned intubations, prolonged ventilation (48 hours), sepsis and mortality (p < 0.05). In the multivariate analysis, statistically significant predictors for pneumonia included age > 65 (OR = 3.2), a recent operation within 30 days (OR = 8.21), a low hematocrit (OR = 3.22), and an increased operative time (OR = 1.006).

Conclusion: Our study utilizes the National Surgical Quality Improvement Program to examine preoperative and intraoperative risk factors associated with pneumonia following cervical spine surgery. Using a multivariate regression model we demonstrated that age, low hematocrit, recent operation, and increased operative time were all independent risk factors for postoperative pneumonia. Development of preoperative protocols based upon these identified risk factors may help decrease the morbidity, mortality, length of stay, and hospital costs associated with pneumonia following cervical spine surgery.