title: Incidence, Risk Factors, and Mortality of Reintubation in Adult Spinal Deformity Surgery.
abstract: METHODS
  Retrospective study of an administrative database.
  
  
  OBJECTIVE
  The objective was to investigate the incidence, risk factors, and mortality rate of reintubation after adult spinal deformity (ASD) surgery.
  
  
  BACKGROUND
  There are limited data regarding the occurrence of reintubation after ASD surgery.
  
  
  METHODS
  The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify adult patients who underwent elective surgery for scoliosis. Patients who required reintubation were identified and compared with controls (no reintubation). A multivariable logistic regression analysis was performed to identify independent factors associated with reintubation.
  
  
  RESULTS
  A total of 9734 patients who underwent surgery for ASD were identified, and 182 required reintubation [1.8%; 95% confidence interval (CI), 1.6%-2.1%] on average 2 days after surgery (range, 0-28 d). After multivariable analysis, the strongest independent risk factors associated with reintubation included postoperative acute respiratory failure [odds ratio (OR), 12.0; 95% CI, 8.6-16.6], sepsis (OR, 6.9; 95% CI, 3.5-13.6), and deep vein thrombosis (OR, 5.7; 95% CI, 3.0-10.9); history of chronic lung disease (OR, 1.6; 95% CI, 1.1-2.3) and fusion of 8 or more segments (OR, 1.5; 95% CI, 1.1-2.2) were also independent risk factors. Mortality rates were significantly higher in reintubated patients (7.3%) compared with that in nonreintubated patients (0.2%, P<0.001). More importantly, reintubation was an independent risk factor for inpatient mortality (OR, 9.8; 95% CI, 4.1-23.5; P<0.001).
  
  
  CONCLUSIONS
  The reintubation rate after ASD surgery is approximately 1.8%. Patients with a history of chronic lung disease and patients undergoing fusion of 8 or more segments may be at an increased risk for reintubation; other associated factors included acute respiratory failure, sepsis, and deep vein thrombosis. Patients who required postoperative airway management after ASD surgery were 9.8 times more likely to die during their hospital stay compared with controls.
authors.affiliation: *Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD †Division of Spinal Surgery, NYU Medical Center-Hospital for Joint Diseases ‡Department of Spine Surgery, Hospital for Special Surgery, New York City, NY.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza Ramos
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013131:Spine / Q000002:abnormalities* / Q000601:surgery*