Characterizing post-operative ICU admission after cervical spondylotic myelopathy surgery

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-13 DOI:10.1016/j.clineuro.2025.108963

Lauren M. Boden , Yixuan A. Pei , Jennifer X. Hong , Lori Jia , Stephen Barchick , David S. Casper , James M. Schuster , Amrit S. Khalsa

{"title":"Characterizing post-operative ICU admission after cervical spondylotic myelopathy surgery","authors":"Lauren M. Boden , Yixuan A. Pei , Jennifer X. Hong , Lori Jia , Stephen Barchick , David S. Casper , James M. Schuster , Amrit S. Khalsa","doi":"10.1016/j.clineuro.2025.108963","DOIUrl":null,"url":null,"abstract":"<div><h3>Study design</h3><div>Retrospective cohort</div></div><div><h3>Objective</h3><div>To characterize variables associated with post-operative intensive care unit (ICU) admission following cervical spondylotic myelopathy (CSM) surgery and determine if ICU stay is associated with increased length of stay (LOS).</div></div><div><h3>Summary of background data</h3><div>Routine post-operative ICU stay for mean arterial pressure monitoring is an established practice after acute spinal cord injury. However, there is no formal recommendation for CSM patients post-operatively. Variability exists in ICU utilization after CSM surgery, with some surgeons routinely sending patients to the ICU while others do not.</div></div><div><h3>Methods</h3><div>Patients who underwent primary, single-approach CSM surgery at a single institution over a two-year span were divided into ICU and non-ICU cohorts based on immediate post-operative destination. Primary outcome was LOS. Secondary outcomes included discharge disposition, complications, clinical status, and reoperation within three years. Propensity score matching (PSM) created matched cohorts of ICU and non-ICU patients. Outcomes were assessed using Mann-Whitney, McNemar, or 2-sided t-tests.</div></div><div><h3>Results</h3><div>452 patients were included in initial analysis. Variables that significantly predicted ICU disposition include age, increased number of stenotic levels, adapted spinal canal occupation ratio, Medicare insurance, management by orthopaedic service, posterior surgical approach, increased surgery duration, and increased estimated blood loss. After PSM to control these variables, non-ICU patients had shorter LOS (2.14 vs 4.14, p < 0.001) and higher rate of discharge to home (83.5 % vs 55.3 %, p = 0.0009) with no difference in neurologic status change or complications at 6 weeks.</div></div><div><h3>Conclusion</h3><div>In CSM patients, routine post-operative ICU admission is associated with longer LOS and discharge to rehabilitation facilities without decreasing post-operative complications compared to patients routinely admitted to the floor.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108963"},"PeriodicalIF":1.8000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurology and Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S030384672500246X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Study design

Retrospective cohort

Objective

To characterize variables associated with post-operative intensive care unit (ICU) admission following cervical spondylotic myelopathy (CSM) surgery and determine if ICU stay is associated with increased length of stay (LOS).

Summary of background data

Routine post-operative ICU stay for mean arterial pressure monitoring is an established practice after acute spinal cord injury. However, there is no formal recommendation for CSM patients post-operatively. Variability exists in ICU utilization after CSM surgery, with some surgeons routinely sending patients to the ICU while others do not.

Methods

Patients who underwent primary, single-approach CSM surgery at a single institution over a two-year span were divided into ICU and non-ICU cohorts based on immediate post-operative destination. Primary outcome was LOS. Secondary outcomes included discharge disposition, complications, clinical status, and reoperation within three years. Propensity score matching (PSM) created matched cohorts of ICU and non-ICU patients. Outcomes were assessed using Mann-Whitney, McNemar, or 2-sided t-tests.

Results

452 patients were included in initial analysis. Variables that significantly predicted ICU disposition include age, increased number of stenotic levels, adapted spinal canal occupation ratio, Medicare insurance, management by orthopaedic service, posterior surgical approach, increased surgery duration, and increased estimated blood loss. After PSM to control these variables, non-ICU patients had shorter LOS (2.14 vs 4.14, p < 0.001) and higher rate of discharge to home (83.5 % vs 55.3 %, p = 0.0009) with no difference in neurologic status change or complications at 6 weeks.

Conclusion

In CSM patients, routine post-operative ICU admission is associated with longer LOS and discharge to rehabilitation facilities without decreasing post-operative complications compared to patients routinely admitted to the floor.

查看原文本刊更多论文

脊髓型颈椎病手术后ICU住院特征分析

研究设计回顾性队列研究目的探讨脊髓型颈椎病（CSM）手术后重症监护病房（ICU）住院的相关变量，并确定ICU住院是否与住院时间（LOS）增加有关。背景资料总结：急性脊髓损伤后，常规ICU住院监测平均动脉压是一种既定的做法。然而，对于脊髓型颈椎病患者的术后治疗，尚无正式的建议。CSM手术后ICU的使用存在差异，一些外科医生常规将患者送到ICU，而另一些则不这样做。方法根据术后即刻目的地，将在单一机构接受初级单入路CSM手术的患者分为ICU组和非ICU组。主要结局为LOS。次要结局包括出院情况、并发症、临床状况和三年内再手术情况。倾向评分匹配（PSM）创建了ICU和非ICU患者的匹配队列。采用Mann-Whitney、McNemar或双侧t检验评估结果。结果452例患者纳入初步分析。显著预测ICU处置的变量包括年龄、狭窄程度增加、椎管占用率、医疗保险、骨科服务管理、后路手术入路、手术时间延长和估计失血量增加。经PSM控制这些变量后，非icu患者的LOS较短（2.14 vs 4.14, p <； 0.001），出院率较高（83.5 % vs 55.3 %,p = 0.0009），6周时神经状态改变或并发症无差异。结论与常规住院相比，CSM患者术后常规ICU住院与术后更长时间的LOS和出院到康复机构相关，但术后并发症并未减少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.