Multivariate analysis of airway obstruction and reintubation after anterior cervical surgery: A Retrospective Cohort Study of 774 patients.
METHODS
A retrospective study.


OBJECTIVE
To explore the risk factors for reintubation after airway obstruction following anterior cervical surgery.


BACKGROUND
Anterior cervical surgery is an effective surgical therapy for cervical spine disorders. As the anterior approach is adopted more frequently, some rare postoperative complications come under the spotlight, among which, airway obstruction is extremely detrimental. However, the risk factors and the pathogenesis of the airway obstruction still remain unknown. Therefore, finding out the incidence rate and the risk factors of airway obstruction after anterior cervical surgery weighs significantly on preventing airway obstruction.


METHODS
We retrospectively analyzed the history and follow-up data of 774 patients who underwent anterior cervical surgery during January 2007 and June 2016. The patients were divided into two groups according to the occurrence of airway obstruction complication. Patients' age, sex, smoking history, drinking history, the presence of diabetes, body mass index (BMI), course of disease, surgical method, the location of the surgical segment, operation duration and the number of surgical segments were recorded and analyzed. Univariate analysis was conducted for the foregoing factors which might associate with concurrent airway obstruction, to screen out statistically significant factors, followed by a multivariate logistic regression analysis to analyze the relationship between these factors and the incidence rate of reintubation for airway obstruction after anterior cervical surgery.


RESULTS
14 of 744 patients developed postoperative airway obstruction followed by reintubation, which makes the incidence rate of 1.81% (14/774) for patients having airway obstruction after anterior cervical surgery. Among the 14 patients, 12 (85.7%) developed airway obstruction within 48 h after surgery, and 2 (14.3%) postoperative showed delayed airway obstruction in 9-11d after surgery. All of them had reintubation. The results of univariate analysis showed that there were statistically significant differences in age, smoking history, body mass index (BMI), surgical method, the location of the surgical segment, operation duration and the number of surgical segments between the two groups (P < 0.05). Multivariate logistic regression analysis showed that age (OR = 2.038, 95% CI = 1.045-4.012), smoking (OR = 1.502, 95% CI = 1.012-2.375), BMI (OR = (OR = 1.807, 95% CI = 1.126-2.842), operation duration (OR = 2.503, 95% CI = 1.580-3.966), surgical method (OR = 3.386, 95% CI = 1.036-3.625), the location of the surgical segment (OR = 2.391, 95% CI = 1.085-5.159) and the number of surgical segments (OR = 2.512, 95% CI = 1.564-3.768) were the risk factors for airway obstruction and reintubation after anterior cervical surgery (P < 0.05).


CONCLUSIONS
Age, smoking, obesity, the number of surgical segments, surgical method and surgical segment location are the important factors which may induce airway obstruction after anterior cervical surgery and therefore led to the decision of reintubations.
Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China.
Haoxi
H
Li
Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China.
Yufeng
Y
Huang
Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China.
Bin
B
Shen
Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China.
Zhaoyu
Z
Ba
Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China. Electronic address: eastspine@yahoo.com.
Desheng
D
Wu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000453:epidemiology* / Q000628:therapy; D015992:Body Mass Index; D002574:Cervical Vertebrae / Q000601:surgery*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*
Airway obstruction; Anterior surgery; Cervical spine; Risk factors