Risk of reintubation in neurosurgical patients

Reintubation among neurosurgical patients is poorly characterized. The aim of this study was to delineate the rate of reintubation among neurosurgical patients. In addition, we seek to characterize the patient demographic features, comorbidities, and surgical characteristics that may be associated with reintubation among neurosurgical patients.

This is a retrospective cohort study conducted in the setting of hospitals participating in the American College of Surgeons' National Surgical Quality Improvement Program between 2005 and 2010. All adult patients undergoing neurosurgery under general anesthesia were included. Exclusion criteria were preoperative mechanical ventilation or pneumonia prior to surgery. Reintubation was defined as placement of an endotracheal tube or mechanical ventilation within 48 h after surgery.

Among 17,483 eligible patients, 74 (0.42 %; 95 % CI 0.33-0.52 %) required reintubation within 48 h of surgery. In multiple logistic regression, the following were associated with increased risk of reintubation: age >65 years (OR 2.1; 95 % CI 1.3-3.4), preoperative renal failure (OR 2.9; 95 % CI 1.0-8.5), quadriplegia (OR 8.2; 95 % CI 3.3-20.3), COPD (OR 2.1; 95 % CI 1.0-4.3), operative time >3 h (OR 2.9; 95 % CI 1.8-4.8), and higher ASA class (OR per point, 2.1; 95 % CI 1.4-3.1). Spinal surgery was found to be protective relative to cranial neurosurgery or endarterectomy (OR 0.3; 95 % CI 0.2-0.5).

Reintubation after neurosurgery is associated with older patients with a greater number of comorbidities. In particular, renal, pulmonary, and severe neurologic comorbidities; longer operative duration; and cranial, rather than spinal, pathology were associated with increased risk for reintubation. These findings may be helpful in triage decisions regarding postoperative intensity of care and monitoring.