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Incidence, Outcomes, and Mortality of Reintubation After Anterior Cervical Fusion

Marquez-Lara, Alejandro MD; Nandyala, Sreeharsha V. BA; Fineberg, Steven J. MD; Singh, Kern MD

doi: 10.1097/BRS.0000000000000098
Cervical Spine

Study Design. Retrospective database analysis.

Objective. To compare perioperative patient characteristics, hospital resource utilization, and early postoperative outcomes in patients requiring reintubation after anterior cervical fusion (ACF).

Summary of Background Data. Airway compromise is a potential complication after anterior cervical surgery. Postsurgical soft-tissue edema or hematoma formation may be so severe that an unplanned reintubation may be required. The rate of reintubation after ACF and the effect on hospital outcomes remains unknown.

Methods. The Nationwide Inpatient Sample database was queried from 2002–2011. Patients undergoing elective ACF procedures for degenerative diagnoses were selected. Those who required an unplanned reintubation after ACF were identified. Patient demographics, comorbidities, length of stay, costs, number of levels fused, and mortality were analyzed. SPSS version 20 was used for statistical analysis and a P < 0.001 denoted statistical significance.

Results. A total of 262,425 patients underwent an elective ACF between 2002 and 2011 of which 1464 patients (5.6 per 1000 cases) required reintubation during their admission. The rate of reintubation was statistically greater for 3+-level fusions than the 1- to 2-level fusion cases. On average, patients requiring reintubation were older and had a greater number of comorbidities. These patients also incurred a significantly greater hospital stay and total hospital costs than unaffected patients. In addition, significant predictors for reintubation included 3+-level fusions, congestive heart failure, anemia, postoperative aspiration pneumonia, hematoma, thromboembolic events, and dysphagia.

Conclusion. The reintubation rate after an elective ACF is 0.5%, and it increases to 1.6% after 3+-level fusions. Older patients with greater comorbidities are at an increased risk for reintubation. Given the greater LOS, costs and mortality associated with reintubation, it is imperative to identify patients at increased risk to help improve patient outcomes and decrease hospital resource utilization.

Level of Evidence: 4

A large retrospective database analysis of 262,425 anterior cervical spinal fusion cases demonstrated a postoperative reintubation incidence of 5.6 per 1000 cases. These reintubations resulted in an increased hospital resource utilization and mortality.

From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Ste 300, Chicago, IL 60612; E-mail:

Acknowledgment date: July 13, 2013. First revision date: September 24, 2013. Acceptance date: October 21, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, and royalties.

© 2014 by Lippincott Williams & Wilkins