title: Critical care in patients undergoing lumbar spine fusion: a population-based study.
abstract: BACKGROUND
  Data on the utilization of critical care services (CCSs) among patients who underwent spine fusion are rare. Given the increasing popularity of this procedure, information regarding demographics and risk factors for the use of these advanced services is needed in order to appropriately allocate resources, educate clinical staff, and identify targets for future research.
  
  
  METHODS
  We analyzed hospital discharge data of patients who underwent lumbar spine fusion in approximately 400 US hospitals between 2006 and 2010. Patient, procedure, and health care system-related demographics for those requiring CCS were compared to those who did not. Outcomes such as mortality, complications, disposition status, and hospital charges were compared among groups and risk factors for the utilization of CCS identified.
  
  
  RESULTS
  A total of 95 434 entries of patients who underwent posterior lumbar spine fusion surgery between 2006 and 2010 were identified. Approximately 10% of the patients required CCS. On average, patients requiring CCS were older and had a higher comorbidity burden, developed more complications, had longer hospital stays and higher costs, and were less likely to be discharged home compared to non-CCS patients. Risk factors with increased odds for requiring CCS included advanced age, increasing comorbidity burden, increasing surgical invasiveness, and presence of postoperative complications, especially pulmonary.
  
  
  CONCLUSIONS
  Approximately, 10% of the patients undergoing lumbar spine surgery require CCS. Utilizing the present data, critical care physicians and administrators can identify patients at risk, educate clinical staff, identify targets for intervention, and allocate resources to meet the needs of this particular patient population.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA MemtsoudisS@hss.edu.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Ottokar
authors.initials: O
authors.lastname: Stundner
authors.affiliation: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Xuming
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Ya-Lin
authors.initials: YL
authors.lastname: Chiu
authors.affiliation: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Anesthesiology, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Fleischut
authors.affiliation: Department of Anesthesiology, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Kerr
authors.affiliation: Department of Orthopedic Surgery/Spine Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
authors.affiliation: Department of Anesthesiology, Division of Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: J Matthias
authors.initials: JM
authors.lastname: Walz
mesh_terms: D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D015897:Comorbidity; D003422:Critical Care; D003710:Demography; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014481:United States
keywords: critical care; epidemiology; neurosurgery; orthopedics; outcomes research; spine