Factors Related to Delayed Extubation in Cervical Spine Surgery in an Academic Hospital: A Retrospective Study of 506 Patients

Objective: The incidence of airway obstruction has been reported to be 1.2­6.1% after cervical spine surgery and up to 27% in posterior occipito-cervical spinal fusion. Communication between the anesthesiologist, surgeon, and staff responsible for postoperative care, and the identifi cation of patients at risk of airway complications are important. We aimed to determine the incidences of delayed extubation and reintubation, and the factors related to delayed extubation after cervical spine surgery. Methods: A review was conducted of the medical records of patients who underwent cervical spine surgery in the orthopedic and neurosurgery units, Siriraj Hospital, between January 2012 and May 2017. The data included demographics, perioperative airway management, postoperative airway complications (delayed extubation and reintubation), and outcomes. Results: Of the 506 patients analyzed, delayed extubation occurred in 116 (22.9%), and 15 (3.0%) were reintubated. The independent related factors for delayed extubation were blood loss ≥ 300 mL (odds ratio [OR], 2.71; 95% confi dence interval [CI], 1.33­5.49); intraoperative fl uid administration ≥ 2,000 mL (OR, 2.17; 95% CI, 1.08­4.36); anesthetic time of ≥ 300 min (OR, 3.74; 95% CI, 1.83­7.63); and case fi nished after service hours (OR, 3.18; 95% CI, 1.73­5.88). Conclusion: The incidence of delayed extubation in cervical spine surgery patients was high, and reintubation was common. Anesthesiologists should be cognizant of the related risk factors before deciding between immediate or delayed extubation.