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J Anesth. 2018 Aug;32(4):565-575. doi: 10.1007/s00540-018-2515-7. Epub 2018 May 28.

Dependent functional status is associated with unplanned postoperative intubation after elective cervical spine surgery: a national registry analysis.

Author information

1
Department of Anesthesiology, University of California, San Diego, 9500 Gilman Dr, MC 0881, La Jolla, San Diego, CA, 92093-0881, USA.
2
Department of Anesthesiology, University of California, San Diego, 9500 Gilman Dr, MC 0881, La Jolla, San Diego, CA, 92093-0881, USA. ragabriel@ucsd.edu.
3
Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA. ragabriel@ucsd.edu.

Abstract

PURPOSE:

The impact of preoperative functional status on 30-day unplanned postoperative intubation and clinical outcomes among patients who underwent cervical spine surgery is not well-described. We hypothesized that functional dependence is associated with 30-day unplanned postoperative intubation and that among the reintubated cohort, functional dependence is associated with adverse postoperative clinical outcomes after cervical spine surgery.

METHODS:

Utilizing the 2007-2016 American College of Surgeons National Surgical Quality Improvement Program database, we identified adult elective anterior and posterior cervical spine surgery patients by Current Procedural Terminology codes. We performed (1) a Cox Proportional Hazard analysis for the following outcomes: reintubation, prolonged ventilator use, and pneumonia and (2) an adjusted logistic regression analysis among patients that required postoperative reintubation to evaluate the association of functional status with adverse postoperative outcomes.

RESULTS:

The sample size was 26,263, of which 550 (2.1%) were functionally dependent. The adjusted model suggested that when compared with functionally independent patients, dependent patients were at increased risk of unplanned 30-day intubation (HR 2.05, 95% CI 1.26-3.34; P = 0.003). The adjusted risk of 30-day postoperative pneumonia was significantly higher in patients with functional dependence (HR 1.61, 95% CI 1.02-2.54, P = 0.036). Among patients that required postoperative reintubation, the odds of 30-day mortality was significantly higher in patients with functional dependence (OR 5.82, 95% CI 1.59-23.4, P < 0.001).

CONCLUSION:

Preoperative functional dependence is a good marker for estimating postoperative unplanned intubation following cervical spine surgery.

KEYWORDS:

Cervical spine surgery; Functional status; Pulmonary complications; Reintubation

PMID:
29808261
DOI:
10.1007/s00540-018-2515-7
[Indexed for MEDLINE]

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