Clinical factors associated with unexpected critical care management and prolonged hospitalization after elective cervical spine surgery

Objectives: To determine preoperative and operative factors associated with the need for unanticipated critical care management and prolonged hospital ization after cervical spine surgery. Design: Retrospective, case controlled study with data collection over 5 yr s. Setting. Intensive care unit at a Veterans Affairs hospital. Patients. A total of 109 patients who underwent elective cervical decompres sion for degenerative disease. Interventions. Anterior or posterior cervical spine surgery. Measurements and Main Results: Data were recorded with regard to pre- and p ostoperative neurologic function, extent of surgery, length and cost of hos pitalization and critical care, and preoperative co-morbidities. Of 109 pat ients, 16 (15%) required critical care management in the early postoperativ e phase (group I). The remainder (n = 93) represented group II. Group I had an average hospital stay of 18.5 days as compared with 6.1 days for group II (p < .001) and a cost difference of approximately $26,000. The incidence of preexisting myelopathy (69%) and the extent of decompression (2.38 leve ls) were greater in group I than group II (27%, p < .005; 1.67 levels, p < .01). The presence of pulmonary disease (p < .03), hypertension (p < .02), cardiovascular disease (p < .05), and diabetes mellitus (p < .002) all were associated with the need for critical care management and longer hospitali zation. Conclusions. In those patients undergoing decompressive cervical surgery fo r degenerative disease, the following factors were linked to the need for u nanticipated, postoperative critical care and longer hospitalization: multi level decompression, preexisting myelopathy, pulmonary disease, cardiovascu lar disease, hypertension, and diabetes mellitus.