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 hospitalization after cervical spine surgery. Design: Retrospective, case controlled study with data collection over 5 yrs. Setting. Intensive care unit at a Veterans Affairs hospital. Patients. A total of 109 patients who underwent elective cervical decompression for degenerative disease. Interventions. Anterior or posterior cervical spine surgery. Measurements and Main Results: Data were recorded with regard to pre- and postoperative neurologic function, extent of surgery, length and cost of hospitalization and critical care, and preoperative co-morbidities. Of 109 patients, 16 (15%) required critical care management in the early postoperative 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 levels) 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 hospitalization. Conclusions. In those patients undergoing decompressive cervical surgery for degenerative disease, the following factors were linked to the need for unanticipated, postoperative critical care and longer hospitalization: multilevel decompression, preexisting myelopathy, pulmonary disease, cardiovascular disease, hypertension, and diabetes mellitus.