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  • Duration of Anesthesia as a Risk Factor for Postoperative Complications in Patients Undergoing Anterior Cervical Discectomy and Fusion

    Final Number:

    Parth Kothari BS; Jeremy Steinberger MD; Javier Z Guzman BS; Nathan John Lee BS; Branko Skovrlj MD; John I Shin BS; Dante Leven DO; John M. Caridi MD; Samuel K Cho MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Anesthesia duration may effect outcomes after anterior cervical discectomy and fusion (ACDF).

    Methods: Adult patients undergoing ACDF from 2005-2012 were identified by the Current Procedural Terminology (CPT) codes in the ACS NSQIP database. Patients were subdivided into quintiles of anesthesia time (Group 1, 48-129 minutes, Group 2, 129-156 minutes, Group 3, 156-190 minutes, Group 4, 190-245 minutes, and Group 5, 245-1025 minutes). Univariate and multivariate analyses were performed to assess the impact of anesthesia duration on 30-day postoperative complications.

    Results: 3,801 patients undergoing ACDF were identified. Mean anesthesia duration was 192.5 +/- 85.31 minutes. 122 (3.21%) had a postoperative complication. In univariate analysis, as anesthesia duration increased, there was a statistically significant increase in overall complications (6.3% in Group 5, compared to 3.0% in Group 4, 2.6% in Group 3, 2.5% in Group 2, 1.6% in Group 1). Specifically, pulmonary complications, intraoperative and postoperative blood transfusions, return to the operating room, and length of stay greater than 5 days were all increased in the groups of longer anesthesia duration. In multivariate analyses, patients in the highest group of anesthesia duration (>245 minutes) had statistically significant increased risk of overall complications (OR 2.71, 95% CI 1.33-5.53, p=0.012), venous thromboembolism (OR 2.69, 95% CI 0.71-10.2, p=0.011), and return to the operating room (OR 2.92, 95% CI 1.24-6.88, p=0.004). The two groups with the longest anesthesia durations (quintiles 4 and 5) had increased total length of stay more than five days (for quintile 4, OR 3.10, 95% CI 1.70-5.64, p=0.0004, for quintile 5, OR 3.61, 95% CI 1.93-6.73, p<0.0001). There was no statistically significant effect of increased anesthesia time on blood transfusions or wound complications.

    Conclusions: Patients with significantly increased anesthesia duration have increased risk of overall complications, venous thromboembolisms, increased length of stays, and return to the operating room.

    Patient Care: Knowledge of gender's effect on surgery can improve patient care.

    Learning Objectives: By the end of this session, participants should be able to analyze whether duration of anesthesia influences complication rates in patients undergoing ACDF.


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