Graduate School of Medicine, University of Ulsan, Seoul, Republic of Korea.
Department of Neurological Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea.
Spine (Phila Pa 1976). 2017 Sep 15;42(18):E1058-E1066. doi: 10.1097/BRS.0000000000002236.
Retrospective comparative cohort analysis.
To evaluate the effect of postoperative airway management protocol (ASAN Extubation Protocol, AEP) on incidence of airway complications for patients undergoing anterior cervical spine surgery (ACSS).
Postoperative airway compromise remains crucial for patients undergoing ACSS. Despite the potential severity of these complications, the data in the published literature addressing this issue is sparse.
A retrospective cohort study was performed regarding airway complications (postoperative airway edema requiring unplanned reintubation or tracheostomy) between groups of patients undergoing ACSS before and after applying our standardized protocol (AEP) for postoperative extubation. The AEP was developed based on 5 clinical risk factors reported having relation to airway complication. Postoperative patients with any oneor more risk factors were kept intubated for at least overnight and extubation was conducted according to the amount of prevertebral soft tissue swelling.
A total of 538 ACSS patients were identified from 2008 to 2016. The nonprotocol group (before protocol application, 275 patients) and the Protocol group (after protocol, 263 patients) were compared; airway complication rates were significantly different between two groups (nonprotocol: 3.64% (10/275) vs.
0.76% (2/263), P = 0.024). The possible factors that may increase airway complication include operative indications (P = 0.002), trauma (P = 0.000), medical comorbidity risk (P = 0.011), combined anterior and posterior surgery (P = 0.002), and operation time longer than 5 hours (P = 0.045). In multivariate analysis, medical comorbidity risk, trauma, and airway protocol adoption were significant factors. AEP reduced the airway complication rate by odds ratio 0.125 (P = 0.013).
Postoperative airway complication is not very common after ACSS. AEP contributed to reduce the incidence of airway complications. The potentially life-threatening event of loss of airway patency, even though it is a rare complication, should be cautiously analyzed with identification of risk factors before the surgery.
回顾性对比队列分析。
评估术后气道管理方案（ASAN 拔管方案，AEP）对接受前路颈椎手术（ACSS）患者气道并发症发生率的影响。
术后气道阻塞仍然是接受 ACSS 的患者的关键问题。尽管这些并发症的潜在严重程度很高，但发表的文献中关于这个问题的数据很少。
对应用我们的标准化拔管方案（AEP）前后接受前路颈椎手术的患者的气道并发症（术后气道水肿需要计划性重新插管或气管切开）进行回顾性队列研究。AEP 是根据与气道并发症相关的 5 个临床危险因素制定的。术后有一个或多个危险因素的患者至少要插管过夜，拔管根据椎前软组织肿胀的程度进行。
共从 2008 年至 2016 年确定了 538 例 ACSS 患者。非方案组（方案应用前，275 例）和方案组（方案后，263 例）进行了比较；两组气道并发症发生率有显著差异（非方案组：3.64%（10/275）比方案组：0.76%（2/263），P=0.024）。可能增加气道并发症的因素包括手术适应证（P=0.002）、创伤（P=0.000）、合并内科并发症风险（P=0.011）、前后联合手术（P=0.002）和手术时间长于 5 小时（P=0.045）。多因素分析显示，内科合并症风险、创伤和气道方案的采用是显著因素。AEP 将气道并发症的发生率降低了 0.125 倍（P=0.013）。
ACSS 后气道并发症并不常见。AEP 有助于降低气道并发症的发生率。即使是罕见的并发症，失去气道通畅的潜在危及生命的事件也应该在手术前仔细分析，并确定危险因素。
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