430 - Risk Factors for Postoperative Re-intubation Following Cervical Spine...

#430 Risk Factors for Postoperative Re-intubation Following Cervical Spine Surgery

Cervical Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

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

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

Abstract

Introduction: Patients who undergo cervical spine surgery (CSS) occasionally require postoperative re-intubation due to airway compromise. Despite the potential severity of this complication, there is limited data in the literature addressing this issue. The purpose of this study was to analyze patient characteristics associated with unplanned re-intubation after CSS and subsequent complications.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was searched to identify patients who underwent cervical spine surgery. Patients who required unplanned re-intubation after CSS were compared to patients that had no airway compromise. Preoperative patient characteristics (demographics, co-morbidities, pre-operative lab values), surgery and hospital outcomes (e.g., operative time, length of stay), 30-day complication rates, and mortality were compared between cohorts. Statistical analysis was performed with SPSS v.20 using independent t-tests and χ2-tests for continuous and categorical variables respectively; p-values ≤ 0.05 were considered statistically significant. A multivariate regression model was created to identify predictors for unplanned re-intubation, using only pre-operative and intraoperative variables that were statistically different.

Results: A total of 8,648 cervical spine surgeries were performed between 2006-2011. Of these, 56 (0.64%) resulted in unplanned postoperative re-intubation. Patients who required re-intubation had a greater mean age (61.7 vs 54.1) than the control group. Demographic data showed a greater percentage of males (62.6% vs 54.0%, p < 0.0001) and African Americans (25.0 vs 9.7%, p < 0.0001) requiring re-intubation. Preoperative comorbidites including diabetes, hypertension and coronary artery disease were more prevalent in the re-intubation group. Finally, albumin levels were lower (3.46 vs 4.13, p < 0.0001) in patients requiring re-intubation. 30-day outcome data revealed a significantly prolonged length of stay and increased risk for pneumonia and mortality in patients who underwent re-intubation when compared to the control group (p < 0.0001). Statistically significant predictors for this rare complication included recent weight loss >10% (OR=5.61, 95% CI=1.08-29.2, p=0.041), prior operation within 30 days (OR=5.83, 95% CI= 1.58-21.5, p=0.008), low hematocrit (OR=2.95, 95% CI=1.42-6.14, p=0.004), and high creatinine (OR=2.34, 95% CI=1.03-5.33, p=0.043).

Conclusion: Postoperative emergency airway management is a rare complication following CSS. Patients who have had recent surgery, low hematocrit, high creatinine and recent weight loss prior to surgery had an increase risk of re-intubation after CSS. In addition, re-intubation was associated with additional complications including pneumonia, sepsis and increased mortality during the hospitalization. Optimizing modifiable risk factors prior to surgery may help avoid airway compromise after CSS and its associated morbidity.