Harris et al identified risk factors for prolonged hospitalization with the need for critical care in patients undergoing elective cervical spine surgery. This can help identify patients who may benefit from preoperative interventions and closer monitoring following surgery. The authors are from the Palo Alto Veterans Affairs Health Care System and the Stanford University Medical Center.


Risk factors for prolonged hospitalization and/or need for critical care following surgery:

(1) decompression of 3 or more levels

(2) posterior approach

(3) pre-existing myelopathy

(4) pulmonary disease

(5) cardiovascular disease

(6) diabetes mellitus

(7) hypertension



• Smoking was not found to be a risk factor. This may be due to either (a) incorporating smoking-related COPD with pulmonary disease or (b) bias towards not doing elective surgery on heavy smokers.

• Swelling of neck with airway compression following extensive surgery may explain some of the need for critical care. Patients with significant myelopathy or lung disease may require intermittent respiratory care.


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