Spinal Deformity, Surgery at the Cervicothoracic Junction, and American Society of Anesthesiologists Class Increase the Risk of Post-surgical Intensive Care Unit Treatment after Dorsal Spine Surgery: A Single-Center Multivariate Analysis of 962 Patients

Jannik Leyendecker; Tobias Prasse; Ahmad Al Rahhal; Christoph Paul Hofstetter; Wolfgang Wetsch; Peer Eysel; Jan Bredow

doi:10.31616/asj.2023.0093

Spinal Deformity, Surgery at the Cervicothoracic Junction, and American Society of Anesthesiologists Class Increase the Risk of Post-surgical Intensive Care Unit Treatment after Dorsal Spine Surgery: A Single-Center Multivariate Analysis of 962 Patients

Asian Spine J. 2023 Dec;17(6):1035-1042. doi: 10.31616/asj.2023.0093. Epub 2023 Nov 10.

Authors

Jannik Leyendecker^{1

2}, Tobias Prasse^{1

2}, Ahmad Al Rahhal¹, Christoph Paul Hofstetter², Wolfgang Wetsch³, Peer Eysel¹, Jan Bredow^{1

4}

Affiliations

¹ Department of Orthopaedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
³ Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.
⁴ Department of Orthopaedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany.

Abstract

Study design: This was a retrospective multivariate analysis of preoperative risk factors leading to intensive care unit (ICU) admissions in patients undergoing elective or acute dorsal spine surgery.

Purpose: Numerous studies have predicted a substantial increase in spine surgeries within the next decades, potentially overwhelming hospitals' resources, including ICU occupancy. Accurate estimates of whether patients need postsurgical ICU treatment are pivotal for both resource allocation and patient safety.

Overview of literature: Risk factors leading to ICU admissions after dorsal spine surgery have been extensively examined for lumbar elective surgery. Studies including other anatomical segments of the spine and nonelective surgery regarding postsurgical ICU treatment probability are lacking.

Methods: This study was designed to be a single-center multivariate analysis of data retrospectively collected from a tertiary care university hospital. Patients undergoing dorsal spine surgery from 2009 to 2019 were included in this study. The patients' demographic data were analyzed to determine potential preoperative risk factors for ICU admission after surgery using multiple logistic regression.

Results: In our cohort, 962 patients with a mean age of 71.1±0.55 years were included. Surgeries involved 3.24±0.08 spinal levels on average. The incidence of ICU treatment after surgery was 30.4% (n=292). Multivariate logistic regression showed a markedly increased odds ratio (OR) for patients undergoing surgery of the cervicothoracic junction (OR, 8.86) and those undergoing surgery for spinal deformity treatment (OR, 7.7). Additionally, cervical procedures (OR, 3.29), American Society of Anesthesiologists (ASA) class 3-4 (OR, 2.74), spondylodiscitis (OR, 2.47), fusion of ≥3 levels (OR, 1.94), and age >75 years (OR, 1.33) were associated with an increased risk of postsurgical ICU admission.

Conclusions: The findings highlight the relevance of anatomical location, preoperative diagnosis, ASA class, and length of surgery regarding the predictability of postoperative ICU admission. Our data allowed for more sophisticated estimates regarding the need for ICU treatment after dorsal spine surgery, guiding the surgeon through patient selection, communication, and ICU admission predictability.

Keywords: Cervicothoracic junction; Intensive care unit admission; Risk factors; Spinal deformity; Spine surgery.