Predictive Analysis of Risk Factors and Clinical Outcomes of Delayed Extubation in Adult Spinal Deformity Surgery

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
BI

Bailey Imbo

United States
TW

Tyler K. Williamson, MS

Medical Student/Clinical Researcher
University of the Incarnate Word SOM
San Antonio, Texas, United States
rJ

rachel Joujon-Roche, n/a

Research Fellow
NYU Langone
Astoria, New York, United States
PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
BD

Bassel Diebo, MD

Spine Surgeon
Brown University
Brooklyn, Rhode Island, United States
SV

Shaleen Vira, MD

Assistant Professor, Orthopaedic Surgery & Neurosurgery
UT Southwestern Medical Center
Dallas, Texas, United States
RL

Renaud Lafage, MS

Senior Biomedical engineer
Lenox Hill Hospital
new york, New York, United States
Virginie Lafage, PhD

AVP, Clinical Research
Lenox Hill | Northwell
Hospital for Special Surgery
New York, New York, United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Introduction: Due to the high physiologic stress adult spinal deformity (ASD) surgery often places upon patients, delayed intubation may be considered to prevent decompensation between stages or after surgery. However, previous studies in thoracolumbar patients have demonstrated may be associated with worsened peri- and post-operative outcomes due to the increased risk of infection or airway edema. Yet, there remains a paucity of literature regarding predictive analysis of delayed extubation in ASD patients.

Purpose: To identify risk factors and predictors of delayed extubation in ASD patients in order to enhance patient selection and reduce peri- and post-operative complication.

Methods: Operative ASD patients ≥18yrs with complete pre-(BL) and 2-year(2Y) postop radiographic/HRQL data were stratified by decision to delay post-operative extubation (Delayed) versus those who were extubated immediately after surgery (Extubated). Differences in demographics, clinical outcomes, and complication rates were assessed via means comparison analysis. Conditional binary backwards logistic regression assessed demographic, surgical, and peri-operative predictors of delayed extubation at α=.05.

Results: 582 patients were included (58.11 ± 11.97 years, 48% female, 29.13 ± 6.89 kg/m2. Of these patients, 53 (9.1%) were classified as Delayed. When comparing staged vs same-day procedures, 96.2% (n=50) of Delayed patients were classified as same-day. At BL, Delayed patients were comparable in gender, BMI, frailty, and CCI (all p>.05). When assessing individual comorbidities, Delayed patients had were significantly more likely to be previously diagnosed with arthritis (58% vs 91%, p=.024). In terms of BL HRQLs, Delayed patients presented with significantly lower scores in SF-36 physical function, general health, and mental health domains (all p<.039). Surgically, Delayed patients had a higher mean operative time, greater use of cell saver, had more levels fused, and more often underwent lateral approach and decompression (all p<.05). Peri-operatively, Delayed patients more often required extended SICU stay (p <.001), and had longer hospital length of stay than Extubated patients (both p<.001). Post-discharge, Delayed patients were significantly likely to not return home and required acute or subacute care (χ2(2) = 20.77, p<.001). By 2Y, no significant differences in major clinical or radiographic complications were noted (p>.05). Predictive modeling demonstrated that female gender, high CCI, elevated EBL, elevated op time, levels fused, and BL anemia were robust predictors of delayed extubation (model p<.001, AUC=.838).

Conclusions: This study demonstrates that female gender, high CCI, elevated intraoperative blood loss, elevated operative time, levels fused, and prior history of anemia is predictive of patients experiencing delayed extubation following corrective spinal deformity surgery resulting in extended SICU and hospital stay. Though no significant difference in complication rates were noted overall, optimization of patients pre-operatively to reduce the risk of delaying extubation should be strongly considered.