Delayed extubation in spine surgery is associated with increased postoperative complications and hospital episode-based resource utilization

Gal, Jonathan S.; Hunter, Samuel; Reich, David L.; Franz, Eric; DeMaría, Samuel; Neifert, Sean N; Lin, Hung‐Mo; Liu, Xiaoyu; Caridi, John M.; Katz, Daniel

doi:10.1016/j.jclinane.2021.110636

Cited by 8 publications

(9 citation statements)

References 32 publications

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“…Among them, 30.97% of patients required postoperative AA retention, which was found to be associated with an increased frequency of pulmonary complications and a poor prognosis. The results of this study are consistent with those of studies of nonneurosurgical patients (9)(10)(11)(12). Prolonged AA retention can lead to complications, including lung infection, glottis narrowing, and difficulty swallowing (13).…”

Section: Discussionsupporting

confidence: 92%

Factors associated with artificial airway retention after skull base chordoma resection: A retrospective cohort study

Yu²,

Cui³

et al. 2022

Front. Neurol.

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BackgroundChordoma is a malignant bone and soft tissue tumor derived from embryonic notochord remnants, and skull base chordoma accounts for ~1/3 of all chordoma cases. Skull base chordoma is closely related to the brainstem and cranial nerves and has a high recurrence rate. The purpose of this study was to investigate the influence of the timing of tracheal extubation on perioperative pulmonary complications. We also aimed to explore predictors of postoperative artificial airway (AA) retention in patients with skull base chordoma.MethodsThis was a single-center, retrospective cohort study. The study population included all skull base chordoma patients undergoing surgical treatment between January 2019 and December 2021 at Beijing Tiantan Hospital. The primary outcome was the incidence of postoperative pulmonary complications. Several patient characteristics were evaluated for potential associations with AA retention.ResultsA total of 310 patients with skull base chordoma were enrolled. The frequency of AA retention after surgery for skull base chordoma was 30.97%. The incidence of postoperative pulmonary complications was much lower in those without AA retention (3.74 vs. 39.58%, P < 0.001). Factors with the highest point estimates for the odds of AA retention included body mass index, cranial nerve involvement, maximum tumor diameter, operative method, hemorrhage volume, operative duration and intraoperative mechanical ventilation duration.ConclusionsIn this retrospective cohort study, most of the factors associated with postoperative airway retention were closely related to the patient's tumor characteristics. These data demonstrate that respiratory management in patients with skull base chordoma remains an ongoing concern.

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Section: Discussionsupporting

confidence: 92%

Factors associated with artificial airway retention after skull base chordoma resection: A retrospective cohort study

Yu²,

Cui³

et al. 2022

Front. Neurol.

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“…Based on previously published document, 6 p.m. was used as the watershed for the timing of the operation, considering that the onset of thoracoscopic lung surgery later than 6 p.m. developed an increased risk of intraoperative complications [ 21 ]. Extubation performed outside the operating room was defined as delayed extubation, which was determined by the anaesthesiologist and thoracic chief surgeon in view of the patient’s preoperative status and intraoperative adverse events [ 5 , 9 , 15 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

“…Prolonged endotracheal intubation is not a beneficial process, which may result in related airway complications regarding pneumonia, laryngeal injury, glottic stenosis and dysphagia [ 5–8 ]. Also, it takes up the limited medical resource, greatly reducing the transition efficiency in post-anaesthesia care unit (PACU) and intensive care unit (ICU) [ 9 ]. Thus, it is of great clinical significance to identify high-risk patients and adjust predictors of delayed extubation in order to reduce its incidence and related complications.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the specific attributes of thoracic surgery, such as unique physiology of one-lung ventilation (OLV) including hypoperfusion or reperfusion, atelectasis or reinflation, and increased inflammatory mediators and postoperative incisional chest wall pain, all increase the uncertainty of postoperative extubation [ 11 , 12 ]. Currently, underlying predictors for delayed extubation have been explored in several fields such as cardiac, thoracotomy, neurosurgical, liver transplantation and spine populations [ 9 , 13–17 ]. However, to date, no document has researched predictors for delayed extubation after thoracoscopic lung cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, by reviewing a large number of medical records, this study aims to explore the incidence and potential predictors and to construct a nomogram to predict the decision to delayed extubation after this surgery. Moreover, considering the reported influence of timing of operation and attending handoff on delayed extubation in other surgical specialties [ 9 , 18 , 19 ], this study also attempts to investigate the interaction of the two factors on delayed extubation.…”

Section: Introductionmentioning

confidence: 99%

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A novel nomogram for predicting the decision to delayed extubation after thoracoscopic lung cancer surgery

et al. 2023

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Objective Delayed extubation was commonly associated with increased adverse outcomes. This study aimed to explore the incidence and predictors and to construct a nomogram for delayed extubation after thoracoscopic lung cancer surgery. Methods We reviewed medical records of 8716 consecutive patients undergoing this surgical treatment from January 2016 to December 2017. Using potential predictors to develop a nomogram and using a bootstrap-resampling approach to conduct internal validation. For external validation, we additionally pooled 3676 consecutive patients who underwent this procedure between January 2018 and June 2018. Extubation performed outside the operating room was defined as delayed extubation. Results The rate of delayed extubation was 1.60%. Multivariate analysis identified age, BMI, FEV 1 /FVC, lymph nodes calcification, thoracic paravertebral blockade (TPVB) usage, intraoperative transfusion, operative time and operation later than 6 p.m. as independent predictors for delayed extubation. Using these eight candidates to develop a nomogram, with a concordance statistic (C-statistic) value of 0.798 and good calibration. After internal validation, similarly good calibration and discrimination (C-statistic, 0.789; 95%CI, 0.748 to 0.830) were observed. The decision curve analysis (DCA) indicated the positive net benefit with the threshold risk range of 0 to 30%. Goodness-of-fit test and discrimination in the external validation were 0.113 and 0.785, respectively. Conclusion The proposed nomogram can reliably identify patients at high risk for the decision to delayed extubation after thoracoscopic lung cancer surgery. Optimizing four modifiable factors including BMI, FEV 1 /FVC, TPVB usage, and operation later than 6 p.m. may reduce the risk of delayed extubation. Key Messages: This study identified eight independent predictors for delayed extubation, among which lymph node calcification and anaesthesia type were not commonly reported. Using these eight candidates to develop a nomogram, we could reliably identify high-risk patients for the decision to delayed extubation. Optimizing four modifiable factors, including BMI, FEV 1 /FVC, TPVB usage, and operation later than 6 p.m. may reduce the risk of delayed extubation.

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Adjunct to Extubation-Noninvasive Mechanical Ventilation

Karim,

Agha,

Esquinas

2023

Noninvasive Ventilation. The Essentials

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Delayed extubation in spine surgery is associated with increased postoperative complications and hospital episode-based resource utilization

Cited by 8 publications

References 32 publications

Factors associated with artificial airway retention after skull base chordoma resection: A retrospective cohort study

Factors associated with artificial airway retention after skull base chordoma resection: A retrospective cohort study

A novel nomogram for predicting the decision to delayed extubation after thoracoscopic lung cancer surgery

Adjunct to Extubation-Noninvasive Mechanical Ventilation

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