Department of Anesthesiology, University of California, San Diego, 9500 Gilman Dr, MC 0881, La Jolla, San Diego, CA, 92093-0881, USA.
Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA.
J Anesth. 2018 Aug;32(4):565-575. doi: 10.1007/s00540-018-2515-7. Epub 2018 May 28.
The impact of preoperative functional status on 30-day unplanned postoperative intubation and clinical outcomes among patients who underwent cervical spine surgery is not well-described. We hypothesized that functional dependence is associated with 30-day unplanned postoperative intubation and that among the reintubated cohort, functional dependence is associated with adverse postoperative clinical outcomes after cervical spine surgery.
Utilizing the 2007-2016 American College of Surgeons National Surgical Quality Improvement Program database, we identified adult elective anterior and posterior cervical spine surgery patients by Current Procedural Terminology codes. We performed (1) a Cox Proportional Hazard analysis for the following outcomes: reintubation, prolonged ventilator use, and pneumonia and (2) an adjusted logistic regression analysis among patients that required postoperative reintubation to evaluate the association of functional status with adverse postoperative outcomes.
The sample size was 26,263, of which 550 (2.1%) were functionally dependent. The adjusted model suggested that when compared with functionally independent patients, dependent patients were at increased risk of unplanned 30-day intubation (HR 2.05, 95% CI 1.26-3.34; P = 0.003). The adjusted risk of 30-day postoperative pneumonia was significantly higher in patients with functional dependence (HR 1.61, 95% CI 1.02-2.54, P = 0.036). Among patients that required postoperative reintubation, the odds of 30-day mortality was significantly higher in patients with functional dependence (OR 5.82, 95% CI 1.59-23.4, P < 0.001).
Preoperative functional dependence is a good marker for estimating postoperative unplanned intubation following cervical spine surgery.
术前功能状态对接受颈椎手术患者术后 30 天计划性外插管和临床结局的影响尚未得到充分描述。我们假设功能依赖与术后 30 天计划性外插管相关，并且在再插管患者队列中，功能依赖与颈椎手术后不良术后临床结局相关。
利用 2007 年至 2016 年美国外科医师学会国家手术质量改进计划数据库，我们通过当前手术过程术语代码识别了接受择期前路和后路颈椎手术的成年患者。我们进行了（1）以下结局的 Cox 比例风险分析：再插管、延长呼吸机使用和肺炎，以及（2）需要术后再插管的患者中调整后的逻辑回归分析，以评估功能状态与不良术后结局的关联。
样本量为 26263 例，其中 550 例（2.1%）为功能依赖。调整后的模型表明，与功能独立的患者相比，依赖的患者发生 30 天计划性外插管的风险增加（HR 2.05，95%CI 1.26-3.34；P=0.003）。功能依赖的患者术后 30 天肺炎的调整风险显著更高（HR 1.61，95%CI 1.02-2.54，P=0.036）。在需要术后再插管的患者中，功能依赖的患者 30 天死亡率的几率显著更高（OR 5.82，95%CI 1.59-23.4，P<0.001）。
术前功能依赖是估计颈椎手术后术后计划性外插管的良好指标。
