The preoperative and intraoperative risk factors for early postoperative mechanical ventilation after scoliosis surgery: A retrospective study

Abstract

Background:Patients undergoing corrective surgery for scoliosis of spine are commonly ventilated in our institute after the operation. Postoperative mechanical ventilation (PMV) and subsequent prolongation of intensive care unit stay are associated with increase in medical expenditure and complications such as ventilator-associated pneumonia. Identification of factors which may contribute to PMV and their modification may help in allocation of resources effectively. The present study was performed to identify preoperative and intraoperative factors associated with early PMV after scoliosis surgery.Methods:One hundred and two consecutive patients who underwent operation for scoliosis correction between January 2006 to July 2011 were reviewed retrospectively. Patients requiring PMV included patients who were not extubated in the operating room and were continued on mechanical ventilation. Preoperative and intraoperative factors which were analysed included age, gender, weight, cardiorespiratory function, presence of kyphosis, number and level of vertebrae involved, surgical approach, whether thoracoplasty was done, duration of surgery, blood loss, fluids and blood transfused, hypothermia and use of antifibrinolytics.Results:The average age of the patients was 14.31±3.78 years with female preponderance (57.8%). Univariate analysis found that longer fusions of vertebrae (more than 8), blood loss, amount of crystalloids infused, blood transfused and hypothermia were significantly associated with PMV (P<0.05). Independent risk factors for PMV were longer fusion (Odds Ratio (OR), 1.290; 95% confidence interval (CI), 1.038-1.604) and hypothermia (OR, 0.096; 95% CI, 0.036-0.254; P<0.05).Conclusion:The authors identified that longer fusions and hypothermia were independent risk factors for early PMV. Implementation of measures to prevent hypothermia may result in decrease in PMV.

Section 9: Home mechanical ventilation in children with kyphoscoliosis

“…We found 11 retrospective studies reporting on 592 pediatric patients undergoing spinal fusion surgery, of whom 134/558 (24%) required prolonged mechanical ventilation, defined as !36 hours (see Table 2). [16][17][18][19][20][21][22][23][24][25][26] It was unclear how many of the patients in the paper by Mills et al remained extubated at !36 hours. 16 Twenty-three (2.5%) of the patients received HMV preoperatively.…”

“…Zhang et al found surgical approach to be the only predictor of prolonged mechanical ventilation in their study, 24 while Gurajala et al found longer vertebral fusions and hypothermia to be associated with prolonged mechanical ventilation. 26 While there is evidence that the degree of impairment of pulmonary function correlates with the need for prolonged mechanical ventilation post-scoliosis repair, there does not appear to be a consensus on the defined cutoff level that best predicts the need for protracted ventilatory support.…”

Postoperative Complications in Patients Undergoing Scoliosis: Review

“…Hypothermia is the first thing come to mind that some studies report most scoliosis cases develop hypothermia delaying emergence, even they are poikilothermic postoperatively. 8 In a study by Gurajala et al, 102 scoliosis patients underwent surgery were followed up and postoperative mechanical ventilation need found to be high in patients with more than 8 vertebrae fused and in patients who are hypothermic intraoperatively. 8 The excess number of vertebrae fused with surgery is associated with increased duration of surgery and increased blood loss, thereby blood transfusion.…”

“…8 In a study by Gurajala et al, 102 scoliosis patients underwent surgery were followed up and postoperative mechanical ventilation need found to be high in patients with more than 8 vertebrae fused and in patients who are hypothermic intraoperatively. 8 The excess number of vertebrae fused with surgery is associated with increased duration of surgery and increased blood loss, thereby blood transfusion. Therefore risk of developing lung injury related to transfusion is increased.…”

“…It's found that thoracic scoliosis, anterior approach surgery and thoracoplasty have no effect on early extubation. 8 Postoperative pulmonary embolism is a rare consequence of idiopathic scoliosis surgery. Only 1 patient has developed symptomatic postoperative deep vein thrombosis (DVT), none developed pul-monary embolism, of 313 patients who have spinal surgery.…”