Background: Respiratory failure is a serious complication that can
adversely affect the hospital course and survival of multiply injured
patients. Some studies have suggested that delayed surgical stabilization of
spine fractures may increase the incidence of respiratory complications.
However, the authors of these studies analyzed small sets of patients and did
not assess the independent effects of multiple risk factors.
Methods: A retrospective cohort study was conducted at a regional
level-I trauma center to identify risk factors for respiratory failure in
patients with surgically treated thoracic and lumbar spine fractures.
Demographic, diagnostic, and procedural variables were identified. The
incidence of respiratory failure was determined in an adult respiratory
distress syndrome registry maintained concurrently at the same institution.
Univariate and multivariate analyses were used to determine independent risk
factors for respiratory failure. An algorithm was formulated to predict
Results: Respiratory failure developed in 140 of the 1032 patients
in the study cohort. Patients with respiratory failure were older; had a
higher mean Injury Severity Score (ISS) and Charlson Comorbidity Index Score;
had greater incidences of pneumothorax, pulmonary contusion, and thoracic
level injury; had a lower mean Glasgow Coma Score (GCS); were more likely to
have had a posterior surgical approach; and had a longer mean time from
admission to surgical stabilization than the patients without respiratory
failure (p < 0.05). Multivariate analysis identified five independent risk
factors for respiratory failure: an age of more than thirty-five years, an ISS
of >25 points, a GCS of =12 points, blunt chest injury, and surgical
stabilization performed more than two days after admission. An algorithm was
created to determine, on the basis of the number of preoperative predictors
present, the relative risk of respiratory failure when surgery was delayed for
more than two days.
Conclusions: Independent risk factors for respiratory failure were
identified in an analysis of a large cohort of patients who had undergone
operative stabilization of thoracic and lumbar spine fractures. Early
operative stabilization of these fractures, the only risk factor that can be
controlled by the physician, may decrease the risk of respiratory failure in
multiply injured patients.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.