Risk Factors for Early Reintubation Following Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF) is a common procedure in the United States. Unanticipated postoperative reintubation after ACDF is a rare but serious complication associated with increased morbidity, mortality, and health care costs. This study identifies risk factors for reintubation after ACDF using a large, contemporary cohort.

This retrospective cohort study examined demographic, clinical, and operative variables associated with unanticipated reintubation within 2 days of ACDF surgery using 2017 to 2022 data from the American College of Surgeons National Surgical Quality Improvement Program. Univariate analyses explored the relationship between variables and reintubation. Variables with P <0.15 were included in a multivariable model using logistic regression.

Unanticipated reintubation occurred in 101 (0.2%) of 41,398 patients. Associated factors identified by univariate analysis included age, sex, race, operative time, corpectomy, number of vertebrae fused, posterior approach, ASA-PS, functional status, and select comorbidities. Using a multivariable model, independent risk factors for reintubation included older age (OR: 1.03, 95% CI: 1.01-1.06), male sex (OR: 1.59, 95% CI: 1.05-2.40), Black race (OR: 2.72, 95% CI: 1.73-4.30), longer operative time (OR per hour 1.20, 95% CI: 1.05-1.36), corpectomy (OR: 2.58, 95% CI: 1.67-3.98), procedures involving 3 or more levels (OR: 1.56, 95% CI: 1.00-2.44), and dependent functional status (OR: 2.99, 95% CI: 1.54-5.79).

This study identified several surgical and nonmodifiable patient risk factors for reintubation after ACDF, which may aid in risk stratification to guide preoperative counseling, surgical planning, and patient disposition. Further research is needed to explore mitigation strategies and the association between race and reintubation.