The Postoperative Airway Compromise Score-First Steps to Developing a Postoperative Tool for the Assessment of Upper Airway-Related Complications Following Anterior Cervical Spine Surgery.

Publication Title

World Neurosurg

Authors

Alexander von Glinski, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
Clifford A Pierre, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Christopher Elia, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
Basem Ishak, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
Periklis Godolias, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
Ronen Blecher, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
Joseph R Detorri
Daniel C Norvell
Luke Jouppi
Julius Gerstmeyer, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Steven A Deem, Neurocritical Care, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.Follow
J Blake Golden, Division of Head and Neck Surgery, Swedish Cancer Institute, Seattle, Washington, USA.Follow
Thomas A Schildhauer
Rod J Oskouian, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Jens R Chapman, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow

Document Type

Article

Publication Date

7-1-2024

Keywords

washington; swedish; swedish neurosciences

Abstract

BACKGROUND: Acute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion. This study aims to develop a score to identify patients at risk of acute postoperative airway compromise (PAC).

METHODS: Potential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified of 1466 patients who underwent elective anterior cervical discectomy and fusion between July 2014 and May 2019. A comparison group was created by a randomized selection process (non-PAC group). Factors associated with PAC and a P value of < 0.10 were entered into a logistic regression model and coefficients contributed to each risk factor's overall score. Calibration of the model was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Quantitative discrimination was calculated, and the final model was internally validated with bootstrap sampling.

RESULTS: We identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, American Society of Anesthesiologists class >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (above C4), and duration of surgery >179 minutes. The final prediction model included 5 predictors with very strong performance characteristics. These 5 factors formed the PAC score, with a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%).

CONCLUSIONS: The acute PAC score demonstrates strong performance characteristics. The PAC score might help identify patients at risk of upper airway compromise caused by surgical site abnormalities.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Surgery

DOI

10.1016/j.wneu.2024.04.156