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Clinical factors associated with unexpected critical care management and prolonged hospitalization after elective
O A Harris1, J B Runnels, P G Matz
1Division of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA.
Objectives:
To determine preoperative and operative factors associated with the need for unanticipated critical care management and prolonged hospitalization after cervical spine surgery.
Design:
Retrospective, case controlled study with data collection over 5 yrs.
Setting:
Intensive care unit at a Veterans Affairs hospital.
Patients:
A total of 109 patients who underwent elective cervical decompression for degenerative disease.
Interventions:
Anterior or posterior cervical spine surgery.
Measurements And Main Results:
Data were recorded with regard to pre- and postoperative neurologic function, extent of surgery, length and cost of hospitalization and critical care, and preoperative co-morbidities. Of 109 patients, 16 (15%) required critical care management in the early postoperative phase (group I). The remainder (n = 93) represented group II. Group I had an average hospital stay of 18.5 days as compared with 6.1 days for group II (p <.001) and a cost difference of approximately $26,000. The incidence of preexisting myelopathy (69%) and the extent of decompression (2.38 levels) were greater in group I than group II (27%, p <.005; 1.67 levels, p <.01). The presence of pulmonary disease (p <.03), hypertension (p <.02), cardiovascular disease (p <.05), and diabetes mellitus (p <.002) all were associated with the need for critical care management and longer hospitalization.
Conclusions:
In those patients undergoing decompressive cervical surgery for degenerative disease, the following factors were linked to the need for unanticipated, postoperative critical care and longer hospitalization: multilevel decompression, preexisting myelopathy, pulmonary disease, cardiovascular disease, hypertension, and diabetes mellitus.