Late to Extubate? Risk Factors and Associations for Delayed Extubation After Adult Cervical Deformity Corrective Surgery.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

Because of proximity of the surgical site to important respiratory structures, patients may undergo delayed extubation after adult cervical deformity (ACD) surgery to manage postoperative airway edema/obstruction. Herein, we evaluate relevant relationships with delayed extubation.

SUMMARY OF BACKGROUND DATA: Delayed extubation is an under-reported perioperative occurrence, with only a few studies conducting case-by-case reviews of prolonged intubation.

METHODS

Operative ACD patients with baseline (BL) were grouped based on whether they experienced delayed extubation (DE), or leaving the OR while still intubated, versus those who were extubated successfully in the OR (non-DE). Means comparison and regression analyses identified predictors of delayed extubation and associations with perioperative complications and outcomes.

RESULTS

Eighty-two patients met inclusion criteria (mean age 62.4±13.0 yr, 52.4% female, Edmonton frailty score: 5.10±2.97, ACFI score: 0.30±0.16, CCI: 1.41±1.73). Fourteen patients left the OR intubated, and one (1.2%) required reintubation. DE cohort demonstrated greater Edmonton frailty scores ( P =0.017) and smoking histories ( P =0.031). There was a significant in EBL ( P =0.021) and rate of transfusions (DE: 27.3% vs. non-DE: 4.8%, P =0.12). Upper instrumented vertebra (UIV) was not associated with DE, whereas a lower LIV increased the likelihood of DE (OR: 1.1, P =0.029). Postoperatively, as expected, there was a significant difference in rate of SICU admissions (DE: 90.9% vs . non-DE: 49.2%, P =0.01), although no significant differences in LOS. Greater cSVA and MGS correction from baseline was associated with increased likelihood of delayed extubation (OR: 1.1, 95% CI: 1.05-1.17, P <0.001; OR: 1.14, 95% CI: 1.05-1.24, P =0.003). Furthermore, delayed extubation was a significant predictor of increased VR-Physical Component Scores ( P =0.013) at six weeks, and DE cohort demonstrated significantly higher VR-PCS and VR-MCS Scores at six weeks ( P =0.01, both).

CONCLUSIONS

Baseline frailty and larger radiographic correction can be associated with delayed extubation, which can impact quality of life perioperatively. Considerations like minimizing intraoperative blood loss and degree of correction could minimize delayed extubation.