117. Predictive analysis of risk factors and clinical outcomes of delayed extubation in adult spinal deformity surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> 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 it may be associated with worsened peri- and postoperative outcomes due to the increased risk of infection or airway edema. Yet, literature regarding predictive analysis of delayed extubation in ASD patients remains scarce. <h3>PURPOSE</h3> To identify risk factors and predictors of delayed extubation in ASD patients in order to enhance patient selection and reduce peri- and postoperative complication. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospective ASD database. <h3>PATIENT SAMPLE</h3> This study included 689 ASD patients. <h3>OUTCOME MEASURES</h3> Peri- and postoperative complication rates; HRQLs. <h3>METHODS</h3> Operative ASD patients 18yrs with complete pre-(baseline [BL]) and 2-year(2Y) postop radiographic/HRQL data were stratified by decision to delay postoperative extubation (Delayed) vs those who were extubated immediately after surgery (Extubated). Differences in demographics, clinical outcomes, and complication rates were assessed via means comparison analysis. Conditional binary backstep logistic regression assessed demographic, surgical, and perioperative predictors of delayed extubation at α=.05. <h3>RESULTS</h3> A total of 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 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 .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). <h3>CONCLUSIONS</h3> 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 postoperative complication rates were noted overall, optimization of patients preoperatively to reduce the risk of delaying extubation should be strongly considered. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.