The Postoperative Airway Compromise Score-First Steps to Developing a Postoperative Tool for the Assessment of Upper Airway-Related Complications Following Anterior Cervical Spine Surgery

Alexander von Glinski; Clifford A Pierre; Christopher Elia; Basem Ishak; Periklis Godolias; Ronen Blecher; Joseph R Detorri; Daniel C Norvell; Luke Jouppi; Julius Gerstmeyer; Steven A Deem; J Blake Golden; Thomas A Schildhauer; Rod J Oskouian; Jens R Chapman

doi:10.1016/j.wneu.2024.04.156

The Postoperative Airway Compromise Score-First Steps to Developing a Postoperative Tool for the Assessment of Upper Airway-Related Complications Following Anterior Cervical Spine Surgery

World Neurosurg. 2024 Apr 29:S1878-8750(24)00730-7. doi: 10.1016/j.wneu.2024.04.156. Online ahead of print.

Authors

Affiliations

¹ Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington, USA; Katholisches Klinikum St. Josef, Orthopedic University Hospital Bochum, Bochum, Germany.
² Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA. Electronic address: clifford.pierre@gmail.com.
³ Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA.
⁴ Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA.
⁵ Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, Essen, Germany.
⁶ Spectrum Research Consulting, Tacoma, Washington, USA.
⁷ Seattle Science Foundation, Seattle, Washington, USA.
⁸ Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
⁹ Neurocritical Care, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
¹⁰ Division of Head and Neck Surgery, Swedish Cancer Institute, Seattle, Washington, USA.
¹¹ Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.

PMID: 38692566
DOI: 10.1016/j.wneu.2024.04.156

Abstract

Background: Acute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion. This study aims to develop a score to identify patients at risk of acute postoperative airway compromise (PAC).

Methods: Potential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified of 1466 patients who underwent elective anterior cervical discectomy and fusion between July 2014 and May 2019. A comparison group was created by a randomized selection process (non-PAC group). Factors associated with PAC and a P value of < 0.10 were entered into a logistic regression model and coefficients contributed to each risk factor's overall score. Calibration of the model was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Quantitative discrimination was calculated, and the final model was internally validated with bootstrap sampling.

Results: We identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, American Society of Anesthesiologists class >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (above C4), and duration of surgery >179 minutes. The final prediction model included 5 predictors with very strong performance characteristics. These 5 factors formed the PAC score, with a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%).

Conclusions: The acute PAC score demonstrates strong performance characteristics. The PAC score might help identify patients at risk of upper airway compromise caused by surgical site abnormalities.

Keywords: Airway; Anterior cervical discectomy and fusion; Compromise; Delphi method; Intubation; Postoperative; Revision surgery; Risk factors; Score.