Success of First Intubation Attempt in Patients With History of Cervical Spine Fusion: A Retrospective Comparison Study

Background: – Cervical spine fusion causes limited neck mobility, a known risk factor for increased difficulty of endotracheal intubation. Cervical spine fusion surgeries are increasingly performed. The objective of this study was to determine the relationship between previous cervical spine fusion and subsequent endotracheal intubation. Materials and Methods: – This retrospective study included adult patients undergoing elective surgery requiring endotracheal intubation between 2015 and 2023. We used multivariable logistic regression to identify variables independently associated with the primary outcome: requiring more than one intubation attempt. Sensitivity analyses examined the outcome within only fusion patients. Results: – We identified 938 patients, 436 with a history of cervical fusion, with 493 intubation attempts, and 502 nonfusion patients with 543 intubation attempts. The majority of the sample (91.5%) had fusion involving C3 or below, with 6.2% having a C1/C2 fusion(2.3% were missing the level of fusion). The success of the first attempt was 89.2% versus 92.6%, 8.5% versus 6.6% second attempt, and 2.3% versus 0.8% third attempt for fusion versus nonfusion patients, respectively. Requiring more than one attempt was associated with short thyromental distance, using multiple laryngoscopes, mouth trauma, and trainee status, but not with spinal fusion status (OR=1.29; 95% confident interval=079-2.12; P=0.312). Conclusion: – Patients with a history of cervical spine fusion undergoing elective intubation experience similar rates of first intubation attempt failure compared with those without fusion when controlling for provider experience. Requiring more than one intubation attempt was associated with short thyromental distance, using multiple laryngoscopes, a trainee provider, and mouth trauma, but not a history of cervical fusion.