Factors associated with prolonged ventilation and reintubation in adult spinal deformity surgery

Prolonged ventilation or reintubation are severe complications after scoliosis surgery, but there is limited data regarding their incidence and risk factors. The purpose of this study is to investigate the incidence and risk factors for prolonged ventilation and reintubation in adult spinal deformity (ASD) surgery. The American College of Surgeons National Surgical Quality Improvement Program database (2007-2013) was reviewed. Inclusion criteria were adult patients over 21 years of age who underwent spinal fusion for ASD. The association between patient/operative characteristics and prolonged ventilation/reintubation was investigated via multivariate analysis. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). There were 1250 patients who underwent ASD surgery and met our inclusion criteria. Among these, there were 34 patients who required prolonged ventilation (2.7%) and 22 patients who underwent reintubation (1.8%). Factors associated with prolonged ventilation after multivariate analysis were history of bleeding disorder (OR 5.67; 95% CI, 1.01-31.83) and operative time over 6 h (OR 3.72; 95% CI, 1.17-11.80). For reintubation, these included older age (OR 1.06; 95% CI, 1.01-1.12), history of bleeding disorder (OR 12.21; 95% CI, 2.03-73.42), and fusion of 13 or more spinal levels (OR 9.14; 95% CI, 1.53-54.63). In conclusion, prolonged ventilation and reintubation in ASD surgery are uncommon events. Older patients, patients with bleeding disorders, and those undergoing long operations and fusion of 13 more spinal segments may be at an increased risk for these occurrences.