Incidence and Factors Affecting Re-intubation after Aterior Cervical Spine Fusion
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Abstract
Background: Anterior cervical decompression and fusion are surgical procedures for cervical spondylotic myelopathy, cervical spinal infections and cervical spinal fractures and dislocations. This procedure can cause complications with a relatively low incidence but all are serious especially respiratory problems. There were 135 cases under gone anterior spinal cord decompression and cervical fusion in Sisaket hospital during 2013 - 2017. There are 10 cases of respiratory complications that required reintubation, 3 of these were dead.
Objective: To review the incidence and risk factors affecting post operative re-intubation and death after anterior cervical decompression and fusion.
Methods: This study was a retrospective cohort study. Medical records of all patients undergone
anterior cervical decompression &fusion surgery between 2013 and 2016 were reviewed. Descriptive statistics were used to describe the general characteristics of the population including frequency, percentage and standard deviation. Chi-square, Fisher exact test and multivariable regression were used to identify risk factors.
Results: There were 135 patients undergone anterior cervical decompression & fusion with 85
males and50 females. The mean age was53.9 years. The diagnosis was categorized into 99 non traumatic cases (91 cervical spondylotic myelopathy, 2herniated nucleus pulposus, 6vertebral osteomyelitis) and 36 traumatic cases. After surgery, all patients were retained ET-tube and able to breathe on their own. The mean time of intubation was 25 hours after surgery. After ET-tube removal, a total of 10 patients (8%) had respiratory complications requiring re-intubation, categorized into 5 traumatic cases and 5 non-traumatic cases. Three of these were dead (2.4%). The variable that was found to have statistically significant association with postoperative re-intubation (P < 0.05) was traumatic cases with complete spinal cord injury. Besides, male patients, patients with underlying medical conditions (alcoholism, hypertension, COPD) and traumatic cases were more likely to be re-intubated after surgery, but were not statistically significant.
Conclusion: Traumatic cases with complete spinal cord injury had statistically significant association
with postoperative re-intubation. Male patients, patients with underlying medical conditions (alcoholism, hypertension, COPD) and traumatic cases were more likely to be re-intubated after anterior cervical decompression and fusion, but were not statistically significant.
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References
Marawar S, Girardi FP, Sama AA, Ma Y, Gaber-Baylis LK, Besculides MC, et al. National trends in anterior cervical fusion procedures. Spine (Phila Pa 1976) 2010;35(15):1454-9. doi: 10.1097/BRS.0b013e3181bef3cb.
Angevine PD, Arons RR, McCormick PC. National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990-1999. Spine (Phila Pa 1976) 2003;28(9):931-9; discussion 940. doi: 10.1097/01.BRS.0000058880.89444.A9.
Alosh H, Riley LH 3rd, Skolasky RL. Insurance status, geography, race, and ethnicity as predictors of anterior cervical spine surgery rates and in-hospital mortality: an examination of United States trends from 1992 to 2005. Spine (Phila Pa 1976) 2009;34(18):1956-62. doi: 10.1097/BRS.0b013e3181ab930e.
Jiang SD, Jiang LS, Dai LY. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review. Arch Orthop Trauma Surg 2012;132(2):155-61. doi: 10.1007/s00402-011-1402-6.
King JT Jr, Abbed KM, Gould GC, Benzel EC, Ghogawala Z. Cervical spine reoperation rates and hospital resource utilization after initial surgery for degenerative cervical spine disease in 12,338 patients in Washington State. Neurosurgery 2009;65(6):1011-22; discussion 1022-3. doi: 10.1227/01.NEU.0000360347.10596.BD.
Wang MC, Chan L, Maiman DJ, Kreuter W, Deyo RA. Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine (Phila Pa 1976) 2007;32(3):342-7. doi: 10.1097/01.brs.0000254120.25411.ae.
Daniels AH, Riew KD, Yoo JU, Ching A, Birchard KR, Kranenburg AJ, et al. Adverse events associated with anterior cervical spine surgery. J Am Acad Orthop Surg 2008;16(12):729-38. doi: 10.5435/00124635-200812000-00005.
Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007;32(21):2310-7. doi: 10.1097/BRS.0b013e318154c57e.
Emery SE, Smith MD, Bohlman HH. Upper-airway obstruction after multilevel cervical corpectomy for myelopathy. J Bone Joint Surg Am 1991;73(4):544-51.
Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 2002;27(9):949-53. doi: 10.1097/00007632-200205010-00013.
Epstein NE, Hollingsworth R, Nardi D, Singer J. Can airway complications following multilevel anterior cervical surgery be avoided? J Neurosurg 2001;94(2 Suppl):185-8. doi: 10.3171/spi.2001.94.2.0185.
Kwon B, Yoo JU, Furey CG, Rowbottom J, Emery SE. Risk factors for delayed extubation after single-stage, multi-level anterior cervical decompression and posterior fusion. J Spinal Disord Tech 2006;19(6):389-93. doi: 10.1097/00024720-200608000-00002.
Suk KS, Kim KT, Lee SH, Park SW. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 2006;30(4):290-4. doi: 10.1007/s00264-005-0072-9.
Marquez-Lara A, Nandyala SV, Fineberg SJ, Singh K. Incidence, outcomes, and mortality of reintubation after anterior cervical fusion. Spine (Phila Pa 1976) 2014;39(2):134-9. doi: 10.1097/BRS.0000000000000098.
Souter MJ, Manno EM. Ventilatory management and extubation criteria of the neurological/neurosurgical patient. Neurohospitalist 2013;3(1):39-45. doi: 10.1177/1941874412463944.
Quintard H, l'Her E, Pottecher J, Adnet F, Constantin JM, De Jong A, et al. Experts' guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF) : In collaboration with the pediatric Association of French-speaking Anaesthetists and Intensivists (ADARPEF), French-speaking Group of Intensive Care and Paediatric emergencies (GFRUP) and Intensive Care physiotherapy society (SKR). Ann Intensive Care 2019;9(1):13. doi: 10.1186/s13613-019-0483-1.
