Safety for cervical corpectomy and diskectomy: univariate and multivariate analysis on predictors for prolonged ICU stay after anterior spinal fusion

Abstract

Aim: Cervical anterior spinal fusion (ASF) with corpectomy has risks of catastrophic acute complications such as airway obstruction requiring re-intubation. Our team has adopted a management plan for all cervical corpectomy patients to be admitted to the intensive care unit (ICU) after the operations for overnight observation. Some of these patients were kept intubated after the operations and transferred to the ICU. This study aims to review the outcome of this practice and to identify independent predictors associated with a prolonged ICU stay. Methods: We reviewed consecutive patients with cervical ASF from January 2010 to June 2018. The primary outcome was the ICU length of stay. Univariate and multivariate analyses were conducted to identify independent risk factors associated with a prolonged ICU stay. In total, 103 patients had ASF during the study period. ICU length of stay for elective ASF was 1.01 day (SD 0.373 days) and was significantly shorter than that for emergency ASF (13.29 days, SD 12.57 days) (p < 0.001). 79.6% (82/103) of the ASF patients were extubated in the operating theatre after surgery. Significantly more corpectomy patients (33.3%) versus ACDF patients (15.1%) were kept intubated to the ICU after the operation (p ¼ 0.037). None required reintubation in the ICU. 90.9% (80/88) of the elective ASF can be discharged from the ICU within 24 hours and only 3.41% (3/88) of the elective ASF had prolonged post-operative stay in the ICU (!48 hours). Results: For prolonged postoperative ICU stay (!48 hours), ICU admission airway status of ASF patients who were either extubated in the OT or kept intubated to ICU had no significant association (p ¼ 0.903). Univariate and multivariate analysis had identified emergency admissions (p ¼ 0.043) and the presence of postoperative neurological deficits (p ¼ 0.031) as independent predictors associated with a prolonged postoperative ICU stay. Conclusion: In conclusion, cervical corpectomy and ASF were safe with minimal acute complications.

Airway Complications After Anterior Cervical Spine Surgery: Etiology and Risk Factors

“…However, some patients were extubated in the operating room immediately after surgery, while others were kept inbutated upon admission to the ICU, and the authors did not mention their rationale or algorithm for choosing one. 48 Revision surgery is a risk factor for the development of postoperative dysphagia, prevertebral edema, and dural tears after ACSS. 14,44 ACSS as a revision surgery for patients with OPLL who have previously undergone posterior cervical laminoplasty is associated with a 42% risk of CSF leak; thus, it is recommended that these patients undergo initial posterior fusion to prevent such challenging revision surgery.…”

“…However, some patients were extubated in the operating room immediately after surgery, while others were kept inbutated upon admission to the ICU, and the authors did not mention their rationale or algorithm for choosing one. 48 …”