PMID- 28538443
OWN - NLM
STAT- MEDLINE
DCOM- 20190617
LR  - 20210114
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 42
IP  - 18
DP  - 2017 Sep 15
TI  - Airway Management Protocol After Anterior Cervical Spine Surgery: Analysis of the 
      Results of Risk Factors Associated With Airway Complication.
PG  - E1058-E1066
LID - 10.1097/BRS.0000000000002236 [doi]
AB  - STUDY DESIGN: Retrospective comparative cohort analysis. OBJECTIVE: To evaluate 
      the effect of postoperative airway management protocol (ASAN Extubation Protocol, 
      AEP) on incidence of airway complications for patients undergoing anterior 
      cervical spine surgery (ACSS). BACKGROUND: Postoperative airway compromise 
      remains crucial for patients undergoing ACSS. Despite the potential severity of 
      these complications, the data in the published literature addressing this issue 
      is sparse. METHODS: A retrospective cohort study was performed regarding airway 
      complications (postoperative airway edema requiring unplanned reintubation or 
      tracheostomy) between groups of patients undergoing ACSS before and after 
      applying our standardized protocol (AEP) for postoperative extubation. The AEP 
      was developed based on 5 clinical risk factors reported having relation to airway 
      complication. Postoperative patients with any oneor more risk factors were kept 
      intubated for at least overnight and extubation was conducted according to the 
      amount of prevertebral soft tissue swelling. RESULTS: A total of 538 ACSS 
      patients were identified from 2008 to 2016. The nonprotocol group (before 
      protocol application, 275 patients) and the Protocol group (after protocol, 263 
      patients) were compared; airway complication rates were significantly different 
      between two groups (nonprotocol: 3.64% (10/275) vs. PROTOCOL: 0.76% (2/263), 
      P = 0.024). The possible factors that may increase airway complication include 
      operative indications (P = 0.002), trauma (P = 0.000), medical comorbidity risk 
      (P = 0.011), combined anterior and posterior surgery (P = 0.002), and operation 
      time longer than 5 hours (P = 0.045). In multivariate analysis, medical 
      comorbidity risk, trauma, and airway protocol adoption were significant factors. 
      AEP reduced the airway complication rate by odds ratio 0.125 (P = 0.013). 
      CONCLUSION: Postoperative airway complication is not very common after ACSS. AEP 
      contributed to reduce the incidence of airway complications. The potentially 
      life-threatening event of loss of airway patency, even though it is a rare 
      complication, should be cautiously analyzed with identification of risk factors 
      before the surgery. LEVEL OF EVIDENCE: 2.
FAU - Kim, Moinay
AU  - Kim M
AD  - Graduate School of Medicine, University of Ulsan, Seoul, Republic of Korea.
FAU - Choi, Il
AU  - Choi I
AD  - Department of Neurological Surgery, Dongtan Sacred Heart Hospital, College of 
      Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea.
FAU - Park, Jin H
AU  - Park JH
AD  - Department of Neurological Surgery, Gangneung Asan Medical Center, University of 
      Ulsan College of Medicine, Seoul, Republic of Korea.
FAU - Jeon, Sang Ryong
AU  - Jeon SR
AD  - Department of Neurological Surgery, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul, Republic of Korea.
FAU - Rhim, Seung C
AU  - Rhim SC
AD  - Department of Neurological Surgery, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul, Republic of Korea.
FAU - Roh, Sung W
AU  - Roh SW
AD  - Department of Neurological Surgery, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul, Republic of Korea.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Airway Management/*adverse effects/*statistics & numerical data
MH  - Comorbidity
MH  - Humans
MH  - Intubation, Intratracheal
MH  - Postoperative Complications
MH  - Postoperative Period
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2017/05/26 06:00
MHDA- 2019/06/18 06:00
CRDT- 2017/05/25 06:00
PHST- 2017/05/26 06:00 [pubmed]
PHST- 2019/06/18 06:00 [medline]
PHST- 2017/05/25 06:00 [entrez]
AID - 00007632-201709150-00009 [pii]
AID - 10.1097/BRS.0000000000002236 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2017 Sep 15;42(18):E1058-E1066. doi: 
      10.1097/BRS.0000000000002236.