Risk factors for pulmonary complication following operative fixation of spine fractures

Publication date: Available online 8 May 2017
Source:The Spine Journal
Author(s): Douglas S Weinberg, Brian Z Hedges, Jonathan E. Belding, Timothy A. Moore, Heather A. Vallier
Background ContextPrevious studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for pulmonary complications.PurposeTo identify factors predictive of perioperative pulmonary complications in patients undergoing fixation of spine fractures.Study Design/SettingRetrospective review, level 1 trauma centerPatient SampleThree-hundred and two patients with spinal fractures who underwent operative fixationOutcome MeasuresPost-operative pulmonary complications (physiologic and functional measures)MethodsDemographic and injury features were recorded, including age, gender, BMI, ASA class, mechanism of injury, injury characteristics, and neurological status. Treatment details, including surgery length, timing, and approach were reviewed. Post-operative pulmonary complications were recorded after a minimum of 6 months' follow-up.ResultsForty-seven pulmonary complications occurred in 42 patients (14%), including pneumonia (35), ARDS (10) and pulmonary embolism (2). Logistic regression found spinal cord injury to be most predictive of pulmonary complications (OR = 4.4, 95% CI 1.9-10.1), followed by severe chest injury (OR 2.7, 95% CI 1.1-6.9) male gender (OR 2.7, 95% CI 1.1-6.8), and ASA classification (OR 2.3, 95% CI 1.4-4.0). Pulmonary complications were associated with significantly longer hospital stays (23.9 vs 7.7 days, p < 0.01), stays in the ICU (19.9 vs 3.4 days, p < 0.01), and increased ventilator times (13.8 days vs 1.9 days, p < 0.01).ConclusionsSeveral factors predicted development of pulmonary complications after operative spinal fracture, including SCI, severe chest injury, male gender, and higher ASA classification. Practitioners should be especially vigilant for post-operative complications and associated injuries following upper thoracic spine fractures. Future study must focus on appropriate interventions necessary for reducing complications in these high-risk patients.



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