The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis

Subaraman Ramchandran; Louis M. Day; Breton Line; Aaron J. Buckland; Peter Passias; Themistocles Protopsaltis; John Bendo; Tessa Huncke; Thomas J. Errico; Shay Bess

doi:10.1093/neuros/nyy226

The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis

Subaraman Ramchandran
, Louis M. Day
, Breton Line
, Aaron J. Buckland
, Peter Passias
, Themistocles Protopsaltis
, John Bendo
, Tessa Huncke
, Thomas J. Errico
, Shay Bess

Research output: Contribution to journal › Article › Research › peer-review

15 Citations (Scopus)

Abstract

BACKGROUND: Patients undergoing multilevel spine surgery are at risk for delayed extubation. OBJECTIVE: To evaluate the impact of type and volume of intraoperative fluids administered during multilevel thoracic and/or lumbar spine surgery on postoperative extubation status. METHODS: Retrospective evaluation of medical records of patients ≥ 18 yr undergoing ≥ 4 levels of thoracic and/or lumbar spine fusions was performed. Patients were organized according to postoperative extubation status: immediate (IMEX; in OR/PACU) or delayed (DEX; outside OR/PACU). Propensity score matched (PSM) analysis was performed to compare IMEX and DEX groups. Volume, proportion, and ratios of intraoperative fluids administered were evaluated for the associated impact on extubation status. RESULTS: A total of 246 patients (198 IMEX, 48 DEX) were included. PSM analysis demonstrated that increased administration of non-cell saver blood products (NCSB) and increased ratio of crystalloid: colloids infused were independently associated with delayed extubation. With increasing EBL, IMEX had a proportionate reduction in crystalloid infusion (R = -0.5, P <. 001), while the proportion of crystalloids infused remained relatively unchanged for DEX (R = -0.27; P =. 06). Twenty-six percent of patients receiving crystalloid: colloid ratio > 3:1 had DEX compared to none of those receiving crystalloid: colloid ratio ≤ 3:1 (P =. 009). DEX had greater cardiac and pulmonary complications, surgical site infections and prolonged intensive care unit and hospital stay (P <. 05). CONCLUSION: PSM analysis of patients undergoing multilevel thoracic and/or lumbar spine fusion demonstrated that increased administration of crystalloid to colloid ratio is independently associated with delayed extubation. With increasing EBL, a proportionate reduction of crystalloids facilitates early extubation.

Original language	English
Pages (from-to)	31-39
Number of pages	9
Journal	Neurosurgery
Volume	85
Issue number	1
DOIs	https://doi.org/10.1093/neuros/nyy226
Publication status	Published - Jul 2019
Externally published	Yes

Keywords

Delayed extubation
Early complications
Fluid resuscitation
Multilevel
Spinal Fusion
Surgical invasiveness

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10.1093/neuros/nyy226

Cite this

Ramchandran, S., Day, L. M., Line, B., Buckland, A. J., Passias, P., Protopsaltis, T., Bendo, J., Huncke, T., Errico, T. J., & Bess, S. (2019). The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis. Neurosurgery, 85(1), 31-39. https://doi.org/10.1093/neuros/nyy226

@article{f8017c2ccf524ba4848c55e067c65c0f,

title = "The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis",

abstract = "BACKGROUND: Patients undergoing multilevel spine surgery are at risk for delayed extubation. OBJECTIVE: To evaluate the impact of type and volume of intraoperative fluids administered during multilevel thoracic and/or lumbar spine surgery on postoperative extubation status. METHODS: Retrospective evaluation of medical records of patients ≥ 18 yr undergoing ≥ 4 levels of thoracic and/or lumbar spine fusions was performed. Patients were organized according to postoperative extubation status: immediate (IMEX; in OR/PACU) or delayed (DEX; outside OR/PACU). Propensity score matched (PSM) analysis was performed to compare IMEX and DEX groups. Volume, proportion, and ratios of intraoperative fluids administered were evaluated for the associated impact on extubation status. RESULTS: A total of 246 patients (198 IMEX, 48 DEX) were included. PSM analysis demonstrated that increased administration of non-cell saver blood products (NCSB) and increased ratio of crystalloid: colloids infused were independently associated with delayed extubation. With increasing EBL, IMEX had a proportionate reduction in crystalloid infusion (R = -0.5, P <. 001), while the proportion of crystalloids infused remained relatively unchanged for DEX (R = -0.27; P =. 06). Twenty-six percent of patients receiving crystalloid: colloid ratio > 3:1 had DEX compared to none of those receiving crystalloid: colloid ratio ≤ 3:1 (P =. 009). DEX had greater cardiac and pulmonary complications, surgical site infections and prolonged intensive care unit and hospital stay (P <. 05). CONCLUSION: PSM analysis of patients undergoing multilevel thoracic and/or lumbar spine fusion demonstrated that increased administration of crystalloid to colloid ratio is independently associated with delayed extubation. With increasing EBL, a proportionate reduction of crystalloids facilitates early extubation.",

keywords = "Delayed extubation, Early complications, Fluid resuscitation, Multilevel, Spinal Fusion, Surgical invasiveness",

author = "Subaraman Ramchandran and Day, \{Louis M.\} and Breton Line and Buckland, \{Aaron J.\} and Peter Passias and Themistocles Protopsaltis and John Bendo and Tessa Huncke and Errico, \{Thomas J.\} and Shay Bess",

note = "Publisher Copyright: Copyright {\textcopyright} 2018 by the Congress of Neurological Surgeons.",

year = "2019",

month = jul,

doi = "10.1093/neuros/nyy226",

language = "English",

volume = "85",

pages = "31--39",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Oxford University Press, USA",

number = "1",

}

Ramchandran, S, Day, LM, Line, B, Buckland, AJ, Passias, P, Protopsaltis, T, Bendo, J, Huncke, T, Errico, TJ & Bess, S 2019, 'The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis', Neurosurgery, vol. 85, no. 1, pp. 31-39. https://doi.org/10.1093/neuros/nyy226

The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis. / Ramchandran, Subaraman; Day, Louis M.; Line, Breton et al.
In: Neurosurgery, Vol. 85, No. 1, 07.2019, p. 31-39.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery

T2 - A Propensity Score Matched Analysis

AU - Ramchandran, Subaraman

AU - Day, Louis M.

AU - Line, Breton

AU - Buckland, Aaron J.

AU - Passias, Peter

AU - Protopsaltis, Themistocles

AU - Bendo, John

AU - Huncke, Tessa

AU - Errico, Thomas J.

AU - Bess, Shay

PY - 2019/7

Y1 - 2019/7

N2 - BACKGROUND: Patients undergoing multilevel spine surgery are at risk for delayed extubation. OBJECTIVE: To evaluate the impact of type and volume of intraoperative fluids administered during multilevel thoracic and/or lumbar spine surgery on postoperative extubation status. METHODS: Retrospective evaluation of medical records of patients ≥ 18 yr undergoing ≥ 4 levels of thoracic and/or lumbar spine fusions was performed. Patients were organized according to postoperative extubation status: immediate (IMEX; in OR/PACU) or delayed (DEX; outside OR/PACU). Propensity score matched (PSM) analysis was performed to compare IMEX and DEX groups. Volume, proportion, and ratios of intraoperative fluids administered were evaluated for the associated impact on extubation status. RESULTS: A total of 246 patients (198 IMEX, 48 DEX) were included. PSM analysis demonstrated that increased administration of non-cell saver blood products (NCSB) and increased ratio of crystalloid: colloids infused were independently associated with delayed extubation. With increasing EBL, IMEX had a proportionate reduction in crystalloid infusion (R = -0.5, P <. 001), while the proportion of crystalloids infused remained relatively unchanged for DEX (R = -0.27; P =. 06). Twenty-six percent of patients receiving crystalloid: colloid ratio > 3:1 had DEX compared to none of those receiving crystalloid: colloid ratio ≤ 3:1 (P =. 009). DEX had greater cardiac and pulmonary complications, surgical site infections and prolonged intensive care unit and hospital stay (P <. 05). CONCLUSION: PSM analysis of patients undergoing multilevel thoracic and/or lumbar spine fusion demonstrated that increased administration of crystalloid to colloid ratio is independently associated with delayed extubation. With increasing EBL, a proportionate reduction of crystalloids facilitates early extubation.

AB - BACKGROUND: Patients undergoing multilevel spine surgery are at risk for delayed extubation. OBJECTIVE: To evaluate the impact of type and volume of intraoperative fluids administered during multilevel thoracic and/or lumbar spine surgery on postoperative extubation status. METHODS: Retrospective evaluation of medical records of patients ≥ 18 yr undergoing ≥ 4 levels of thoracic and/or lumbar spine fusions was performed. Patients were organized according to postoperative extubation status: immediate (IMEX; in OR/PACU) or delayed (DEX; outside OR/PACU). Propensity score matched (PSM) analysis was performed to compare IMEX and DEX groups. Volume, proportion, and ratios of intraoperative fluids administered were evaluated for the associated impact on extubation status. RESULTS: A total of 246 patients (198 IMEX, 48 DEX) were included. PSM analysis demonstrated that increased administration of non-cell saver blood products (NCSB) and increased ratio of crystalloid: colloids infused were independently associated with delayed extubation. With increasing EBL, IMEX had a proportionate reduction in crystalloid infusion (R = -0.5, P <. 001), while the proportion of crystalloids infused remained relatively unchanged for DEX (R = -0.27; P =. 06). Twenty-six percent of patients receiving crystalloid: colloid ratio > 3:1 had DEX compared to none of those receiving crystalloid: colloid ratio ≤ 3:1 (P =. 009). DEX had greater cardiac and pulmonary complications, surgical site infections and prolonged intensive care unit and hospital stay (P <. 05). CONCLUSION: PSM analysis of patients undergoing multilevel thoracic and/or lumbar spine fusion demonstrated that increased administration of crystalloid to colloid ratio is independently associated with delayed extubation. With increasing EBL, a proportionate reduction of crystalloids facilitates early extubation.

KW - Delayed extubation

KW - Early complications

KW - Fluid resuscitation

KW - Multilevel

KW - Spinal Fusion

KW - Surgical invasiveness

UR - https://www.scopus.com/pages/publications/85068110947

U2 - 10.1093/neuros/nyy226

DO - 10.1093/neuros/nyy226

M3 - Article

C2 - 29850844

AN - SCOPUS:85068110947

SN - 0148-396X

VL - 85

SP - 31

EP - 39

JO - Neurosurgery

JF - Neurosurgery

IS - 1

ER -

The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis

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Keywords

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