Risk factors for pulmonary complication following fixation of spine fractures.

Abstract Background Context Previous studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for pulmonary complications. Purpose To identify factors predictive of perioperative pulmonary complications in patients undergoing fixation of spine fractures. Study Design/Setting Retrospective review, level 1 trauma center Patient Sample Three-hundred and two patients with spinal fractures who underwent operative fixation Outcome Measures Post-operative pulmonary complications (physiologic and functional measures) Methods Demographic and injury features were recorded, including age, gender, BMI, ASA class, mechanism of injury, injury characteristics, and neurological status. Treatment details, including surgery length, timing, and approach were reviewed. Post-operative pulmonary complications were recorded after a minimum of 6 months' follow-up. Results Forty-seven pulmonary complications occurred in 42 patients (14%), including pneumonia (35), ARDS (10) and pulmonary embolism (2). Logistic regression found spinal cord injury to be most predictive of pulmonary complications (OR = 4.4, 95% CI 1.9-10.1), followed by severe chest injury (OR 2.7, 95% CI 1.1-6.9) male gender (OR 2.7, 95% CI 1.1-6.8), and ASA classification (OR 2.3, 95% CI 1.4-4.0). Pulmonary complications were associated with significantly longer hospital stays (23.9 vs 7.7 days, p Conclusions Several factors predicted development of pulmonary complications after operative spinal fracture, including SCI, severe chest injury, male gender, and higher ASA classification. Practitioners should be especially vigilant for post-operative complications and associated injuries following upper thoracic spine fractures. Future study must focus on appropriate interventions necessary for reducing complications in these high-risk patients.