Late to Extubate? Risk Factors and Associations for Delayed Extubation After Adult Cervical Deformity Corrective Surgery
Bibliographic record
Abstract
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Because of proximity of the surgical site to important respiratory structures, patients may undergo delayed extubation after adult cervical deformity (ACD) surgery to manage postoperative airway edema/obstruction. Herein, we evaluate relevant relationships with delayed extubation. SUMMARY OF BACKGROUND DATA: Delayed extubation is an under-reported perioperative occurrence, with only a few studies conducting case-by-case reviews of prolonged intubation. METHODS: Operative ACD patients with baseline (BL) were grouped based on whether they experienced delayed extubation (DE), or leaving the OR while still intubated, versus those who were extubated successfully in the OR (non-DE). Means comparison and regression analyses identified predictors of delayed extubation and associations with perioperative complications and outcomes. RESULTS: Eighty-two patients met inclusion criteria (mean age 62.4±13.0 yr, 52.4% female, Edmonton frailty score: 5.10±2.97, ACFI score: 0.30±0.16, CCI: 1.41±1.73). Fourteen patients left the OR intubated, and one (1.2%) required reintubation. DE cohort demonstrated greater Edmonton frailty scores ( P =0.017) and smoking histories ( P =0.031). There was a significant in EBL ( P =0.021) and rate of transfusions (DE: 27.3% vs. non-DE: 4.8%, P =0.12). Upper instrumented vertebra (UIV) was not associated with DE, whereas a lower LIV increased the likelihood of DE (OR: 1.1, P =0.029). Postoperatively, as expected, there was a significant difference in rate of SICU admissions (DE: 90.9% vs . non-DE: 49.2%, P =0.01), although no significant differences in LOS. Greater cSVA and MGS correction from baseline was associated with increased likelihood of delayed extubation (OR: 1.1, 95% CI: 1.05-1.17, P <0.001; OR: 1.14, 95% CI: 1.05-1.24, P =0.003). Furthermore, delayed extubation was a significant predictor of increased VR-Physical Component Scores ( P =0.013) at six weeks, and DE cohort demonstrated significantly higher VR-PCS and VR-MCS Scores at six weeks ( P =0.01, both). CONCLUSIONS: Baseline frailty and larger radiographic correction can be associated with delayed extubation, which can impact quality of life perioperatively. Considerations like minimizing intraoperative blood loss and degree of correction could minimize delayed extubation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".