Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
Department of Orthopedics, 966 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Dandong, 118000, China.
Eur Spine J. 2024 Aug;33(8):3069-3081. doi: 10.1007/s00586-024-08313-7. Epub 2024 Jun 22.
Prolonged mechanical ventilation (PMV) and reintubation are among the most serious postoperative adverse events associated with malignant cervical tumors. In this study, we aimed to clarify the incidence, characteristics, and risk factors for PMV and reintubation in target patients.
This retrospective nested case-control study was performed between January 2014 and January 2020 at a large spinal tumor center in China. Univariate analysis was used to identify the possible risk factors associated with PMV and reintubation. Logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) with covariates of a probability < 0.05 in univariate analysis.
From a cohort of 560 patients with primary malignant (n = 352) and metastatic (n = 208) cervical tumors, 27 patients required PMV and 20 patients underwent reintubation. The incidence rates of PMV and reintubation were 4.82% and 3.57%, respectively. Three variables (all p < 0.05) were independently associated with an increased risk of PMV: Karnofsky Performance Status < 50 compared to ≥ 80, operation duration ≥ 8 h compared to < 6 h, and C4 nerve root encased by the tumor. Longer operative duration and preoperative hypercapnia (all p < 0.05) were independent risk factors for postoperative reintubation, both of which led to longer length of stay (32.6 ± 30.8 vs. 10.7 ± 5.95 days, p < 0.001), with an in-hospital mortality of 17.0%.
Our results demonstrate the risk factors for PMV or reintubation after surgery for malignant cervical tumors. Adequate assessment, early detection, and prevention are necessary for this high-risk population.
延长机械通气（PMV）和再插管是与恶性宫颈肿瘤相关的最严重的术后不良事件之一。在这项研究中，我们旨在阐明目标患者中 PMV 和再插管的发生率、特征和危险因素。
这是一项在中国一家大型脊柱肿瘤中心进行的回顾性巢式病例对照研究，时间为 2014 年 1 月至 2020 年 1 月。单因素分析用于确定与 PMV 和再插管相关的可能危险因素。Logistic 回归分析用于估计具有单因素分析中概率<0.05 的协变量的优势比（OR）和 95%置信区间（CI）。
在一组 560 例原发性恶性（n=352）和转移性（n=208）宫颈肿瘤患者中，27 例患者需要 PMV，20 例患者进行了再插管。PMV 和再插管的发生率分别为 4.82%和 3.57%。3 个变量（均 p<0.05）与 PMV 风险增加独立相关：卡氏功能状态<50 与≥80，手术时间≥8 h 与<6 h，C4 神经根被肿瘤包裹。较长的手术时间和术前高碳酸血症（均 p<0.05）是术后再插管的独立危险因素，两者均导致住院时间延长（32.6±30.8 与 10.7±5.95 天，p<0.001），院内死亡率为 17.0%。
我们的结果表明了恶性宫颈肿瘤手术后发生 PMV 或再插管的危险因素。对于这一高危人群，充分评估、早期发现和预防是必要的。
