Risk factors of postoperative respiratory complication following posterior correction for spinal scoliosis

English Keywords:Postoperative complication  Scoliosis surgery  Respiratory system  Perioperative risk factors

English Abstract:

  【Abstract】 Objectives： To investigate the risk factors of postoperative respiratory complication(RC) in patients undergoing posterior scoliosis correction and to establish a predictive model as guidance for clinical management. Methods: The perioperative data of 306 patients undergoing posterior scoliosis correction under general anesthesia from July 2006 to December 2011 in the First Affiliated Hospital of Sun Yat-sen University were collected. There were 98 males and 208 females with an average age of 16.3 years(SD, 5.8 years, range 6-35 years old). The patents′ sex, age, height, weight, preoperative main thoracic Cobb angle, course of disease, preoperative pulmonary function, preoperative neutrophil and neutrophil-to-lymphocyte ratio(NLR), surgery types, surgery time, anesthesia time, duration of intratracheal duct, total intravenous anesthetics(TIVA), crystalloid/colloidal intraoperatively, lower intraoperative systolic blood pressure(SBP), intraoperative blood loss, temperature, peak airway pressure, number of pedicle screws, fusion segments, use of methylprednisolone, blood transfusion, postoperative analgesic methods and drugs, ICU staying, postoperative delirium and so on were recorded. The potential perioperative risk factors of postoperative RC were identified and a predictive model of individual RC risk was established using univariate analysis and multivariate Logistic regression. Results: After searching the patient medical record database in our hospital retrospectively, 306 patients undergoing scoliosis surgery were included in the study. The incidence of postoperative RC was 19.0%(58/306). Univariate analysis showed statistically significant difference(P<0.05) between two tested groups with respect to course of disease, preoperative main thoracic Cobb angle, preoperative neutrophil and NLR, preoperative pulmonary function, surgery types, anesthesia time, surgery time, duration with intratracheal duct, crystalloid/colloidal intraoperatively, intraoperative blood loss, number of pedicle screws, fusion segments, TIVA, high dose of methylprednisolone, postoperative delirium, ICU staying, postoperative analgesia methods. Logistic regression showed that the risk factors of postoperative RC included time of anesthesia(X1), the usage of TIVA(X2), thoracic Cobb angle(X3), number of fusion segments(X4), postoperative delirium(X5) and blood loss during surgery(X6). The predictive equation was P=1/[1+exp(0.020X1-1.407X2-0.060X3+0.574X4+4.023X5+0.087X6-8.742)]. Conclusions: Patients with a greater thoracic Cobb angle, more fusion segments, more blood loss during scoliosis surgery, and suffering postoperative delirium are more likely to suffer postoperative RC. Longer time of anesthesia and the use of TIVA could increase the risk of RC.