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Who Remains Intubated After Adult Spinal Deformity Surgery? A 5-Factor Scoring System With Dual Institution External
Harsh Jain1, Karan Joseph2, Anthony E Bishay3
1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Operative Neurosurgery (Hagerstown, Md.)
|July 29, 2026
Summary
About 15% of adult spinal deformity surgery patients require prolonged intubation past postoperative day 1. A new risk score using age, operative time, and intraoperative factors can help predict this outcome.
Area of Science:
- Spinal Surgery
- Anesthesiology
- Patient Outcomes
Background:
- Prolonged intubation is a common complication after adult spinal deformity (ASD) surgery.
- Risk factors for prolonged intubation in ASD surgery patients are not well understood.
Purpose of the Study:
- To determine the rate of prolonged intubation (until postoperative day 1) in ASD surgery patients.
- To develop and validate a scoring system to predict prolonged intubation after ASD surgery.
Main Methods:
- Retrospective cohort study of 233 adult spinal deformity surgery patients (2009-2021).
- Primary outcome: intubation until postoperative day 1 or beyond.
- External validation of a developed risk score using an independent cohort.
Main Results:
- 15% of patients (36/233) remained intubated until postoperative day 1.
- Factors associated with prolonged intubation include older age, longer operative time, late procedure end times, change of anesthetists, greater blood loss, and intraoperative transfusion.
- A risk score incorporating age ≥60, intraoperative transfusion, operative time >7 hours, change of anesthetists, and procedure end time after 17:00 showed good predictive ability (AUC=0.8) in the derivation cohort and moderate ability (AUC=0.7) in the validation cohort.
Conclusions:
- A significant proportion of ASD surgery patients experience prolonged intubation.
- The developed 8-point risk score effectively identifies patients at higher risk for prolonged intubation.
- This score can aid in early risk stratification and perioperative planning for ASD surgery patients.