392 - Incidence, Risk Factors and Outcomes of Postoperative Airway Managemen...

#392 Incidence, Risk Factors and Outcomes of Postoperative Airway Management after 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: Patients that undergo extensive cervical spine surgery occasionally require postoperative airway monitoring and mechanical ventilation. Few studies have evaluated the risk factors and complications associated with these postoperative events. The purpose of this study was to identify the risk factors and related 30-day complications associated with postoperative airway compromise after cervical spine surgery (CSS).

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried to identify patients who underwent a CSS Patients who required a prolonged intubation >48 hours or an unplanned re-intubation after CSS were compared to those without airway compromise. Preoperative patient characteristics (demographics, comorbidities, preoperative lab values), intraoperative and hospital outcomes (e.g., operative time, length of stay, 30-day complication 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. A multivariate regression model was utilized to identify the independent predictors for prolonged intubation and unplanned re-intubation following a CSS. A p-value ≤ 0.05 denoted statistical significance.

Results: A total of 8,648 cervical spine procedures were identified from 2006-2011 of which 54 patients (0.62%) required prolonged ventilation and 56 patients (0.64%) underwent a postoperative re-intubation. Patients that required postoperative airway management were older and demonstrated a greater comorbidity burden (p< 0.05). In addition, the affected cohorts demonstrated a significantly greater rate of readmission and reoperation as well as a greater incidence of postoperative complications and mortality (p< 0.05). Regression analysis identified the independent predictors for prolonged ventilation to include a history of cardiac disease and dialysis along with a low preoperative albumin (p< 0.05). Similarly, independent risk factors for postoperative re-intubation include recent weight loss >10%, recent operation within 30 days, low preoperative hematocrit, and a high serum creatinine (p< 0.05).

Conclusion: Postoperative airway compromise requiring an unplanned re-intubation or a prolonged intubation >48 hours is a rare complication following CSS. However, this potentially catastrophic event carries a greater rate of postoperative complications and mortality. Further studies are warranted to mitigate the risk factors for postoperative airway compromise in an effort to improve outcomes.