The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation Following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis

Subaraman Ramchandran; Louis M Day; Breton Line; Aaron J Buckland; Peter Passias; Themistocles Protopsaltis; John Bendo; Tessa Huncke; Thomas J Errico; Shay Bess

doi:10.1093/neuros/nyy226

The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation Following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis

Neurosurgery. 2019 Jul 1;85(1):31-40. doi: 10.1093/neuros/nyy226.

Affiliations

¹ Department of Orthopedic surgery, NYU Hospital for Joint Diseases, New York, New York.
² Department of Orthopedic surgery, Rocky Mountain Scoliosis and spine center, Denver, Colorado.
³ Department of Anesthesiology, NYU Hospital for Joint Diseases, New York, New York.

PMID: 29850844
DOI: 10.1093/neuros/nyy226

Abstract

Background: Patients undergoing multilevel spine surgery are at risk for delayed extubation.

Objective: To evaluate the impact of type and volume of intraoperative fluids administered during multilevel thoracic and/or lumbar spine surgery on postoperative extubation status.

Methods: Retrospective evaluation of medical records of patients ≥ 18 yr undergoing ≥ 4 levels of thoracic and/or lumbar spine fusions was performed. Patients were organized according to postoperative extubation status: immediate (IMEX; in OR/PACU) or delayed (DEX; outside OR/PACU). Propensity score matched (PSM) analysis was performed to compare IMEX and DEX groups. Volume, proportion, and ratios of intraoperative fluids administered were evaluated for the associated impact on extubation status.

Results: A total of 246 patients (198 IMEX, 48 DEX) were included. PSM analysis demonstrated that increased administration of non-cell saver blood products (NCSB) and increased ratio of crystalloid: colloids infused were independently associated with delayed extubation. With increasing EBL, IMEX had a proportionate reduction in crystalloid infusion (R = -0.5, P < .001), while the proportion of crystalloids infused remained relatively unchanged for DEX (R = -0.27; P = .06). Twenty-six percent of patients receiving crystalloid: colloid ratio > 3:1 had DEX compared to none of those receiving crystalloid: colloid ratio ≤ 3:1 (P = .009). DEX had greater cardiac and pulmonary complications, surgical site infections and prolonged intensive care unit and hospital stay (P < .05).

Conclusion: PSM analysis of patients undergoing multilevel thoracic and/or lumbar spine fusion demonstrated that increased administration of crystalloid to colloid ratio is independently associated with delayed extubation. With increasing EBL, a proportionate reduction of crystalloids facilitates early extubation.

Keywords: Delayed extubation; Early complications; Fluid resuscitation; Multilevel; Spinal Fusion; Surgical invasiveness.

MeSH terms

Airway Extubation*
Female
Fluid Therapy / methods*
Humans
Lumbar Vertebrae
Male
Middle Aged
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Propensity Score
Retrospective Studies
Spinal Fusion / adverse effects
Spinal Fusion / methods*
Thoracic Vertebrae