Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2017; 8(6): 465-470
Published online Jun 18, 2017. doi: 10.5312/wjo.v8.i6.465
Emergent reintubation following elective cervical surgery: A case series
Joshua Schroeder, Stephan N Salzmann, Alexander P Hughes, James D Beckman, Jennifer Shue, Federico P Girardi
Joshua Schroeder, Stephan N Salzmann, Alexander P Hughes, James D Beckman, Jennifer Shue, Federico P Girardi, Spine Service, Hospital for Special Surgery, New York, NY 10021, United States
Author contributions: Schroeder J designed and performed the research, analyzed the data and wrote the paper; Salzmann SN analyzed the data and wrote the paper; Hughes AP designed the research and provided clinical advice; Beckman JD designed the research and provided clinical advice; Shue J analyzed the data and provided research advice; Girardi FP designed the research and provided clinical advice.
Institutional review board statement: This retrospective case series has received approval from the authors’ institutional review board.
Informed consent statement: For the patients presented in this case series, a waiver of patient informed consent and U.S. Health Insurance Portability and Accountability Act (HIPAA) authorization were sought. Information contained in this case report contains no personal identifiers to ensure patient confidentiality and protections. Under these provisions, the Institutional Review Board (IRB) at our institution provided approval of this study (IRB#2014-062).
Conflict-of-interest statement: The authors declare that they have no conflicts of interest concerning this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Federico P Girardi, MD, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States. girardif@hss.edu
Telephone: +1-212-6061559 Fax: +1-212-7742870
Received: January 21, 2017
Peer-review started: January 21, 2017
First decision: March 8, 2017
Revised: April 20, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: June 18, 2017
Abstract
AIM

To review cases of emergent reintubation after cervical surgery.

METHODS

Patients who were emergently intubated in the post-operative period following cervical surgery were identified. The patients’ prospectively documented demographic parameters, medical history and clinical symptoms were ascertained. Pre-operative radiographs were examined for the extent of their pathology. The details of the operative procedure were discerned.

RESULTS

Eight hundred and eighty patients received anterior- or combined anterior-posterior cervical surgery from 2008-2013. Nine patients (1.02%) required emergent reintubation. The interval between extubation to reintubation was 6.2 h [1-12]. Patients were kept intubated after reintubation for 2.3 d [2-3]. Seven patients displayed moderate postoperative edema. One patient was diagnosed with a compressive hematoma which was subsequently evacuated in the OR. Another patient was diagnosed with a pulmonary effusion and treated with diuretics. One patient received a late debridement for an infected hematoma. Six patients reported residual symptoms and three patients made a complete recovery.

CONCLUSION

Respiratory compromise is a rare but potentially life threatening complication following cervical surgery. Patients at increased risk should be monitored closely for extended periods of time post-operatively. If the airway is restored adequately in a timely manner through emergent re-intubation, the outcome of the patients is generally favorable.

Keywords: Cervical surgery, Complication, Airway compromise, Reintubation, Hematoma

Core tip: The rate of cervical spine surgery has increased over the last years. Airway compromise is a rare but potentially life threatening complication following this type of procedure. This case series represents a single institution’s experience of 9 cases requiring emergent reintubation after anterior- or combined anterior-posterior cervical spine surgery. Besides reporting patient characteristics and operative details, our approach to evaluating and treating these cases is presented. In addition the literature addressing reintubation after cervical spine surgery is reviewed.