Operative neurosurgery (Hagerstown, Md.) · 2026
Who Remains Intubated After Adult Spinal Deformity Surgery? A 5-Factor Scoring System With Dual Institution External Validation.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Jain Harsh, Joseph Karan, Bishay Anthony E, Ahluwalia Ranbir, Zeoli Tyler, Younus Iyan, Tang Alan R, Peterson Keyan, Chanbour Hani, Vogl Samuel, Wang Matthew, Galla Jeffrey T, Ruiz Cardozo Miguel A, Poulin Noah D, Yahanda Alexander T, Molina Camilo A, Wilson Bayard R, Abtahi Amir M, Stephens Byron F, Zuckerman Scott L
Аннотация
BACKGROUND AND OBJECTIVES: Prolonged intubation is an unwanted occurrence after adult spinal deformity (ASD) surgery, yet its risk factors are poorly understood. For patients undergoing ASD surgery, we sought to: (1) report the rate of intubation until postoperative day 1 (POD 1), (2) create a scoring system to predict it, and (3) externally validate the scoring system.
METHODS: A retrospective cohort study (2009-2021) was performed for patients undergoing ASD surgery. Primary outcome was prolonged intubation (POD 1 or beyond). Univariate logistic regression were performed. External validation was performed using an independent cohort.
RESULTS: Among 233 patients, 36 (15%) remained intubated until at least POD 1. These patients were older (70 vs 62 years, P = .001), had longer surgeries (543 vs 398 minutes, P < .001), late procedure end times (18:34 vs 15:59, P < .001), change of anesthetists (56% vs 31%, P = .04), greater blood loss (2809 vs 1207 mL, P < .001), and required intraoperative blood transfusion (89% vs 54%, P < .001). For every extra 30 minutes the case continued, odds of prolonged intubation increased by 22% (odds ratio = 1.2, 95% CI: 1.1-1.3, P < .001). The final scoring system included: age 60 years and older, intraoperative blood transfusion, operative time >7 hours, change of anesthetists, and procedure close time after 17:00. Receiver operating characteristic analysis revealed a cutoff of >4 points as a predictor of prolonged intubation (area under the curve = 0.8, 95% CI: 0.8-0.9, P < .001, sensitivity = 89%, specificity = 70%). On external validation, the score demonstrated moderate discriminative ability (area under the curve = 0.7). At the threshold of 4, sensitivity was 91%, and specificity was 26%.
CONCLUSION: Approximately 15% ASD surgery patients remained intubated through POD 1. An 8-point risk score incorporating age 60 years and older, operative time ≥7 hours, intraoperative transfusion, change of anesthetists, and procedure end time after 17:00 demonstrated strong discrimination in the derivation cohort and moderate, high-sensitivity performance on external validation. Use of this score in collaboration with anesthesia teams may enable early risk stratification and targeted perioperative planning.
METHODS: A retrospective cohort study (2009-2021) was performed for patients undergoing ASD surgery. Primary outcome was prolonged intubation (POD 1 or beyond). Univariate logistic regression were performed. External validation was performed using an independent cohort.
RESULTS: Among 233 patients, 36 (15%) remained intubated until at least POD 1. These patients were older (70 vs 62 years, P = .001), had longer surgeries (543 vs 398 minutes, P < .001), late procedure end times (18:34 vs 15:59, P < .001), change of anesthetists (56% vs 31%, P = .04), greater blood loss (2809 vs 1207 mL, P < .001), and required intraoperative blood transfusion (89% vs 54%, P < .001). For every extra 30 minutes the case continued, odds of prolonged intubation increased by 22% (odds ratio = 1.2, 95% CI: 1.1-1.3, P < .001). The final scoring system included: age 60 years and older, intraoperative blood transfusion, operative time >7 hours, change of anesthetists, and procedure close time after 17:00. Receiver operating characteristic analysis revealed a cutoff of >4 points as a predictor of prolonged intubation (area under the curve = 0.8, 95% CI: 0.8-0.9, P < .001, sensitivity = 89%, specificity = 70%). On external validation, the score demonstrated moderate discriminative ability (area under the curve = 0.7). At the threshold of 4, sensitivity was 91%, and specificity was 26%.
CONCLUSION: Approximately 15% ASD surgery patients remained intubated through POD 1. An 8-point risk score incorporating age 60 years and older, operative time ≥7 hours, intraoperative transfusion, change of anesthetists, and procedure end time after 17:00 demonstrated strong discrimination in the derivation cohort and moderate, high-sensitivity performance on external validation. Use of this score in collaboration with anesthesia teams may enable early risk stratification and targeted perioperative planning.