title: Risk factors for delayed extubation after single-stage, multi-level anterior cervical decompression and posterior fusion.
abstract: Airway difficulties after single-stage, multilevel anterior and posterior cervical surgery are potentially life-threatening complications. Although extubation delays can occur, overnight intubation can reduce the risk of postoperative airway emergencies. Our protocol was as follows: all patients were kept intubated overnight in an intensive care unit and examined by the intensive care unit staff each morning. Readiness for extubation was based on the cuff-leak test, and extubation done on patients beyond the first postoperative day was considered delayed. Eleven patients were extubated on the first postoperative day (group 1), and 11 extubated beyond day 1 (group 2). No airway emergencies occurred. Patient factors-age, weight, smoking, medical comorbidities, American Society of Anesthesiologist class-were not significantly related to extubation delay. There were no differences between groups in the number of anterior and posterior levels or anterior and posterior operative times. Delayed extubation was significantly related to total operative time (8.2 hours vs. 10.6 hours), volume of crystalloid replacement (3,627 cm3 vs. 6,218 cm3) and intraoperative blood transfused (0.7 units vs. 3.1 units); approaching significance was increased blood loss (1,238 mL vs. 2,820 mL). We have found intraoperative factors-operative time, crystalloid volume, blood loss and replacement-rather than patient characteristics, to be risk factors for delayed extubation. Good communication with anesthesia staff and careful attention to postoperative airway management is essential after single-stage, multilevel anterior cervical decompression and posterior fusion.
authors.affiliation: The Boston Spine Group, Boston, MA 02120, USA. bkwon@nebh.org
authors.forename: Brian
authors.initials: B
authors.lastname: Kwon
authors.forename: Jung U
authors.initials: JU
authors.lastname: Yoo
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Furey
authors.forename: James
authors.initials: J
authors.lastname: Rowbottom
authors.forename: Sanford E
authors.initials: SE
authors.lastname: Emery
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D003131:Combined Modality Therapy / Q000009:adverse effects; D019299:Decompression, Surgical / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007440:Intubation / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors