Incidence, Risk Factors, and Outcomes of Postoperative Airway Management After Cervical Spine Surgery

Study Design. Retrospective database analysis. Objective. To identify the incidence and risk factors for a prolonged intubation or an unplanned reintubation after cervical spine surgery (CSS). Summary of Background Data. Patients who undergo CSS occasionally require prolonged mechanical ventilation or an unplanned reintubation for airway support. Despite the potential severity of these complications, there are limited data in the published literature addressing this issue. Methods. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent a CSS. Patients who required a prolonged intubation more than 48 hours or an unplanned reintubation after CSS were compared with those without airway compromise. Preoperative patient characteristics, intraoperative variables, hospital length of stay, 30-day complication rates, and mortality were compared between the cohorts. An alpha <= 0.001 denoted statistical significance. A multivariate regression model was used to identify independent predictors for a prolonged intubation and an unplanned reintubation. Results. A total of 8648 cervical spine procedures were identified from 2006 to 2011 of which 54 patients (0.62%) required prolonged ventilation and 56 patients (0.64%) underwent a postoperative reintubation. Patients who required postoperative airway management were older and demonstrated a greater comorbidity burden (P < 0.001). In addition, the affected cohorts demonstrated a significantly greater rate of readmissions, reoperations, postoperative complications, and mortality (P < 0.001). Regression analysis identified the independent predictors for prolonged ventilation to include a history of cardiac disease and dialysis along with a low preoperative albumin level (P < 0.05). Similarly, the independent risk factors for a postoperative reintubation included a history of recent weight loss more than 10%, recent operation within 30 days, low preoperative hematocrit, and a high serum creatinine (P < 0.05). Conclusion. Postoperative airway management is a rare complication after CSS. A prolonged intubation and an unplanned reintubation carry a greater rate of postoperative complications and mortality. High-risk patients should be identified prior to surgery to mitigate the risk factors for postoperative airway compromise.