• Steven J Fineberg, Matthew Oglesby, Alpesh A Patel, and Kern Singh.
• *Rush University Medical Center, Chicago, IL †Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; and ‡Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
• Spine. 2013 Sep 1;38(19):E1189-95.

Study DesignRetrospective national database analysis.ObjectiveA population-based database was analyzed to characterize the incidence, mortality, and associated risk factors for aspiration pneumonia in cervical spine surgery.Summary Of Background DataAspiration pneumonia represents a potentially fatal complication of any surgical procedure. The incidence of this complication is not well characterized after cervical spine surgery.MethodsData from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing anterior cervical fusion, posterior cervical fusion, or posterior cervical decompression for radiculopathy and/or myelopathy were identified. Patient demographics, incidence of aspiration, costs, and mortalities were assessed. Statistical analysis was performed using Student t test for discrete variables and χ test for categorical data. Logistic regression was used to identify independent predictors for aspiration.ResultsA total of 202,694 patients were identified in the Nationwide Inpatient Sample from 2002 to 2009. Of these, 166,633 were anterior cervical fusions (82.2%), 13,298 were posterior cervical fusions (6.6%), and 22,764 were posterior cervical decompressions (11.2%). The overall incidence of aspiration was 5.3 events per 1000 cases. The greatest incidence was demonstrated in posterior cervical fusion-treated patients with 13.7 per 1000 cases, followed by posterior cervical decompressions with 6.4 per 1000 and anterior cervical fusions with 4.5 per 1000. Patients affected by aspiration were significantly older, more frequently male, and had greater comorbidities than unaffected patients (P < 0.001). Patients diagnosed with aspiration demonstrated significantly greater length of stay, costs, and mortality (P < 0.001). Logistic regression analysis demonstrated independent predictors of aspiration to include advanced age (≥65 yr), male sex, congestive heart failure, coagulopathy, neuropsychiatric disorders, and weight loss (P < 0.001).ConclusionWe demonstrated an overall incidence of 5.3 cases of aspiration per 1000 cervical procedures. Patients most commonly affected by aspiration were older males with greater comorbidity. Hospital courses complicated by aspiration had greater length of stay, costs, and mortality. Identification of patients with risk factors for aspiration may assist in early diagnosis and treatment to prevent further morbidity and mortality.

32 keywords...

hide…