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Incidence, risk factors, and outcomes of postoperative airway management after cervical spine surgery

Nandyala, Sreeharsha V; Marquez-Lara, Alejandro; Park, Daniel K; Hassanzadeh, Hamid; Sankaranarayanan, Sriram; Noureldin, Mohamed; Singh, Kern
STUDY DESIGN/METHODS: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/BACKGROUND: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 α ≤ 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/CONCLUSIONS: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. LEVEL OF EVIDENCE/METHODS:3.
PMID: 24480959
ISSN: 1528-1159
CID: 4482522

Sentinel events in cervical spine surgery

Marquez-Lara, Alejandro; Nandyala, Sreeharsha V; Hassanzadeh, Hamid; Noureldin, Mohamed; Sankaranarayanan, Sriram; Singh, Kern
STUDY DESIGN/METHODS:Retrospective cohort. OBJECTIVE:A national population-based database was queried to investigate the incidence of sentinel events in cervical spine surgery as well as the associated perioperative outcomes. SUMMARY OF BACKGROUND DATA/BACKGROUND:Sentinel events in cervical spine surgery are potentially catastrophic complications. The incidence and perioperative outcomes associated with sentinel events in cervical spine surgery have not been well characterized. METHODS:The Nationwide Inpatient Sample was queried from 2002 to 2011. Patients who underwent elective cervical spinal surgery were identified. Sentinel events including esophageal perforation, vascular injury, nerve injury, retention of foreign objects, and wrong-site surgery were identified. Patient demographics, comorbidities (Charlson Comorbidity Index), surgical procedures, length of stay, total hospital costs, and postoperative outcomes were assessed. The risk for in-hospital mortality associated with each complication was calculated using a 95% confidence interval (CI). Statistical analysis was performed with SPSS version 20, and a P ≤ 0.001 denoted significance. RESULTS:A total of 251,318 cervical spine procedures were identified between 2002 and 2011, of which 123 patients (0.5 per 1000 cases) incurred sentinel events. Circumferential cervical fusion (anterior-posterior cervical fusion) demonstrated an increased risk of vascular injury (odds ratio [OR], 4.5; CI, 1.8-11.2), whereas cervical total disc replacement was associated with an increased risk of esophageal perforation (OR, 10.9; CI, 1.4-85.2) and nerve injury (OR, 36.4; CI, 1.5-892.3). Posterior cervical fusions were associated with an increased risk of wrong-site surgery (OR, 3.9; CI, 1.5-10.5). The sentinel event cohort incurred longer hospitalization, greater costs, mortality, and greater incidence of postoperative complications. CONCLUSION/CONCLUSIONS:This database analysis demonstrates that sentinel events are associated with a significant increase in hospital resource utilization and worsened perioperative outcomes. The type of cervical spine procedure and the number of fusion levels significantly impact the risk of sentinel events. Further research is warranted to understand the etiology of sentinel events in cervical spine surgery and to implement protocols to mitigate the associated risk factors. LEVEL OF EVIDENCE/METHODS:4.
PMID: 24480955
ISSN: 1528-1159
CID: 4482512