Efficacy of Airway Management Protocol for Cervical Anterior Surgery, Posterior Occipitocervical Fusion, and Intramedullary Tumor Resection.

Abstract

Introduction: Surgical interventions for cervical spine and spinal cord diseases may lead to life-threatening postoperative airway obstruction, requiring urgent airway management. This study aimed to assess the feasibility and effectiveness of our respiratory management protocol for patients undergoing anterior cervical approaches, posterior occipitocervical fusion, and intramedullary tumor resection.

Methods: This single-center retrospective study consisted of 497 patients who underwent cervical surgeries, including anterior fusion, posterior occipitocervical fusion, combined anterior and posterior fusions, and intramedullary tumor resection between January 2006 and June 2022. Our institution implemented a specific postoperative airway management protocol from September 2014 onward. The protocol involved continued intubation for at least the first postoperative night, followed by a spontaneous breathing trial with a cuff leak test and extubation one or more days after surgery. We compared the outcomes between the pre-protocol period (non-protocol group, n=234) and the protocol period (protocol group, n=263).

Results: There were no significant between-group differences regarding demographic, clinical, or surgical details. In the non-protocol group, four subjects required reintubation because of postoperative airway complications (anterior fusion: 1 patient, posterior occipitocervical fusion: 1 patient, and intramedullary tumor resection: 2 patients). After the airway protocol implementation, the reintubation rate dropped to zero (P=0.048).

Conclusions: Our airway management protocol substantially reduced the need for reintubation. These findings emphasize the importance of postoperative respiratory management after cervical spine surgeries and underscore the need for appropriate measures to prevent complications.