505: FACTORS ASSOCIATED WITH INTENSIVE CARE UTILIZATION AFTER ADULT SPINAL DEFORMITY SURGERY

Abstract

Introduction: Adult spinal deformity surgery (SDS) has a higher morbidity and mortality relative to other elective spinal procedures, and patients often require post-operative intensive care unit (ICU) admission. The goal of this study is to describe the type and frequency of ICU-specific needs after SDS and identify risk factors for these interventions. Methods: This was a single center, retrospective analysis of adult patients admitted to the ICU after elective SDS over a 6-year period. Demographics and ICU interventions (vasoactive medications, mechanical ventilation (MV), etc.) were recorded. Chi-square test and two sample t-tests were performed to determine risk factors for ICU needs. Results: 236 patient records were analyzed (mean age 68 + 9 years; 65% women). The most common surgery was long-segment thoracolumbar fusion for scoliosis (86%). Mean ICU and hospital lengths of stay (LOS) were 1.6 and 6.2 days, respectively; 2 (0.85%) patients died in the ICU. 42 (18%) required vasoactive medications and 17 (7%) needed MV (15 returned from the operating room (OR) intubated, 1 was re-intubated in the OR, 1 was re-intubated in the ICU for bronchospasm); all patients were extubated safely within 24 hours of ICU admission. Post-operative blood product transfusion was common (65%); 140 (59%) patients received red blood cells (mean units 1.28 + 1.4, max 8). Other ICU events included symptomatic arrhythmias in 14 (6%), acute kidney injury in 8 (3.4%), and acute pulmonary edema in 11 (4.7%). 75% of patients used continuous analgesic or sedative infusions. Age and gender were not significantly different in those requiring ICU interventions versus those who did not. Estimated blood loss (EBL) was associated with post-operative MV (p< 0.0001) and vasopressors (p = 0.04), while length of segmental fusion was associated with MV (p = 0.0001) only. Conclusions: ICU interventions (MV, vasopressors) were required in 53 (22%) patients undergoing SDS, suggesting that ICU destination after SDS is warranted. Intensivists should expect a moderate number of patients to need critical care interventions in the absence of intra-operative complications, however, most patients have a short ICU LOS. In this study, EBL and spinal fusion length was associated with the need for ICU-specific care.