Intensive Care Unit Admission After Spine Surgery: A Narrative Review

Ahmad Assi; Mohammad Daher; Ziad Zalaquett; Marven Aoun; Bryan Youssef; Gaby Kreichati; Khalil Kharrat; Amer Sebaaly

doi:10.14444/8593

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Table 1

Summary of the findings of studies assessing risk factors for ICU admission and LOS after spine surgery.

Study	No. of Patients	Procedure	Outcome
Kay et al, 20166	808	Laminectomy, with or without fusion	Blood loss, operative time, heart disease, age, and female gender were determined to be risk factors for ICU admission following spine surgery. Hypertension, body mass index, and diabetes did not reach significance.
Harris et al, 20019	109	Anterior or posterior cervical spine surgery	Diabetes mellitus (P < 0.002), hypertension (P < 0.02), lung disease (P < 0.03), and heart disease (P < 0.05) were linked to an increased risk of ICU admission.
Adogwa et al, 201810	293	Spine decompression and fusion	Chronic kidney disease was associated with an increased rate of ICU admission (P = 0.04).
Cloney et al, 201911	6869	Spinal fusion	Bleeding disorders (P = 0.028), comorbid disease burden (P < 0.001), male gender (P < 0.001), and BMI (P = 0.027) were patient-related variables correlated to ICU admission following spine surgery. Transfusions (P < 0.001), lumbar procedures (P < 0.001), corpectomies (P = 0.007), fracture repairs (P < 0.001), osteotomies (P = 0.006), blood loss (P = 0.009), and operative time greater than 4 h (P < 0.001) were medical and surgical factors predictive of the need for ICU management.
Daubs et al, 201612	65	Pediatric substraction osteotomy	The occurrence of a major complication increased the length of ICU stay.
Raad et al, 201813	425	Adult spinal deformity surgery	Preoperative opioid use was a risk factor for increased ICU LOS (P = 0.004).
Line et al, 202214	261	Adult spinal deformity surgery	Opioid users were more likely to experience longer ICU stays than patients who were not opioid users (P = 0.0065).
Nahtomi-Shick et al, 200115	103	Spinal decompression without or with fusion and/or instrumentation and other procedures	Age, platelet, and crystalloid administration were predictive of length of ICU stay (P = 0.000).
Martini et al, 202116	1124	Posterior cervical discectomy and fusion	Primary posterior cervical discectomy and fusion was associated with an increased rate of ICU admission compared with the revision procedure (P = 0.0005).
Myers et al, 202117	465	Spinal fracture surgery	Neurosurgical management of spine fractures was linked to a greater risk of the need for intensive care compared with orthopedic management (P = 0.04).
Hartin et al, 201318	364	Lumbar and thoracic fusion surgery	The fusion risk score was an effective indicator of ICU admission, blood loss, and operative time (P < 0.0001).
Deogaonkar et al, 201819	242	Lumbar and thoracic fusion surgery	The fusion risk score was an effective indicator of ICU admission (P < 0.01), blood loss (P < 0.001), and operative time (P < 0.001).
Howe et al, 201120	103	Spinal fusion	Estimated blood loss (P < 0.001) and staged procedures (P < 0.001) were correlated with ICU LOS. Gender, operative time, and procedure invasiveness did not correlate with any outcome.
Lenga et al, 202221	416	Decompression, with or without fusion	Instrumentation increased the risk for a protracted ICU LOS (P < 0.001).

Abbreviations: ICU, intensive care unit; LOS, length of stay.

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Table 2

Summary of the findings of studies assessing risk-predicting scores after spine surgery.

Study	No. of Patients	Procedure	Outcome
Hartin et al, 201318	364	Thoracic or lumbar and fusion	The fusion risk score was a reliable indicator of ICU admission (P < 0.0001), blood loss (P < 0.0001), and operative time (P < 0.0001).
Deogaonkar et al, 201819	242	Lumbar and thoracic fusion surgery	The fusion risk score was an effective indicator of ICU admission (P < 0.01), blood loss (P < 0.001) and operative time (P < 0.001).
Nahtomi-Shick et al, 200115	103	Spinal decompression without or with fusion and/or instrumentation and other procedures	The ASA score was correlated with age and predictive of length of stay (P = 0.000) and ICU length of stay (P = 0.012).
Howe et al, 201120	103	Spinal fusion	The ASA grade was correlated with ICU length of stay (P = 0.011). The ASA grade was also associated with complications (P = 0.030) and discharge to skilled nursing facilities (P = 0.008). The CCI was correlated with complications (P = 0.028) and discharge to skilled nursing facilities (P = 0.039).
Kay et al, 20166	808	Laminectomy, with or without fusion	The ASA score was a predictive factor of ICU admission (P = 0.008).
Ibrahim et al, 202022	101	Multilevel spinal fusion	Lower ASA and CCI scores were consistent with greater patient-perceived improvement in health.
Khechen et al, 201923	298	Single-level minimally invasive transforaminal lumbar interbody fusion	A higher CCI was associated with greater ICU costs (P = 0.002) and higher likelihood of complication (P = 0.005).

Abbreviations: ASA, American society of Anesthesiologists; CCI, Charlson Comorbidity Index; ICU, intensive care unit.

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Table 3

Summary of the findings of studies that evaluated risk-mitigating procedures.

Study	No. of Patients	Procedure	Outcome
Elsamadicy et al, 201727	643	Multilevel (at least 4 levels) spinal fusion	Although patients who benefited from intraoperative monitoring had greater operative times (P < 0.0001), they had a smaller likelihood of being admitted to the ICU (P = 0.015).
Menapace et al, 202328	53	Posterior spinal fusion for neuromuscular scoliosis	Patients who were operated on by 2 cosurgeons tended to undergo greater corrections (P = 0.089), but in shorter operative (P = 0.0025) and anesthesia times (P = 0.0018) when compared with patients who underwent surgery by a single spine surgeon, with the group, despite only showing a nonsignificant trend toward a lesser rate of ICU admission (P = 0.36).
Landi et al, 201729	166	Thoracic and lumbar fracture repair	ICU LOS was decreased and neurological function was improved in patients who had early fracture repair (P = 0.001).

Abbreviations: ICU, intensive care unit; LOS, length of stay.

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Table 4

Summary of the findings of studies that assessed postoperative and post-ICU admission outcomes.

Study	No. of Patients	Procedure	Outcome
Yue et al, 201830	442	C2 fracture repair	ICU admission was more predictive of lung infection (P = 0.001) and overall complications (P = 0.005) than floor admission.
Cloney et al, 202231	1147	Anterior lumbar fusion	The need for intensive care management was significantly correlated with the occurrence of vascular thromboembolic events (P = 0.005).
Cho et al, 202032	3933	Degenerative lumbar disease surgery	ICU admission was found to be a risk factor for hospital readmission within 1 month of discharge (P < 0.001) when comparing to the subset of patients who did not experience readmission.
Lim et al, 200633	-	-	ICU admission increased the likelihood of infection in patients following traumatic spine injury surgery.
Yousef et al, 201834	76	Neuromuscular scoliosis correction surgery	ICU length of stay (P = 0.001) and operative time (P = 0.02) were risk factors for postoperative fever.
Yearly et al, 202235	112	Spine deformity surgery	A stay in the ICU greater than 1 day was a risk factor for the occurrence of a major complication (P < 0.05).
Cloney et al, 201911	6869	Spinal fusion	Patients who underwent spine surgery and were admitted to the ICU had a rate of venous thromboembolic events of 10.2 % while all spine surgery patients had a rate of thromboembolic events of 2.5%.
Harris et al, 20019	109	Anterior or posterior cervical spine surgery	Heart disease and lung failure were the leading causes of mortality in the ICU after spine surgery.