title: Clinical factors associated with unexpected critical care management and prolonged hospitalization after elective cervical spine surgery.
abstract: OBJECTIVE
  To determine preoperative and operative factors associated with the need for unanticipated critical care management and prolonged hospitalization after cervical spine surgery.
  
  
  METHODS
  Retrospective, case controlled study with data collection over 5 yrs.
  
  
  METHODS
  Intensive care unit at a Veterans Affairs hospital.
  
  
  METHODS
  A total of 109 patients who underwent elective cervical decompression for degenerative disease.
  
  
  METHODS
  Anterior or posterior cervical spine surgery.
  
  
  RESULTS
  Data were recorded with regard to pre- and postoperative neurologic function, extent of surgery, length and cost of hospitalization and critical care, and preoperative co-morbidities. Of 109 patients, 16 (15%) required critical care management in the early postoperative phase (group I). The remainder (n = 93) represented group II. Group I had an average hospital stay of 18.5 days as compared with 6.1 days for group II (p <.001) and a cost difference of approximately $26,000. The incidence of preexisting myelopathy (69%) and the extent of decompression (2.38 levels) were greater in group I than group II (27%, p <.005; 1.67 levels, p <.01). The presence of pulmonary disease (p <.03), hypertension (p <.02), cardiovascular disease (p <.05), and diabetes mellitus (p <.002) all were associated with the need for critical care management and longer hospitalization.
  
  
  CONCLUSIONS
  In those patients undergoing decompressive cervical surgery for degenerative disease, the following factors were linked to the need for unanticipated, postoperative critical care and longer hospitalization: multilevel decompression, preexisting myelopathy, pulmonary disease, cardiovascular disease, hypertension, and diabetes mellitus.
authors.affiliation: Division of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA.
authors.forename: O A
authors.initials: OA
authors.lastname: Harris
authors.forename: J B
authors.initials: JB
authors.lastname: Runnels
authors.forename: P G
authors.initials: PG
authors.lastname: Matz
mesh_terms: D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D003422:Critical Care / Q000379:methods*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013130:Spinal Stenosis / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome