Does intraoperative fluid management in spine surgery predict intensive care unit length of stay?

Study Objective: To determine whether intraoperative fluid management in spine surgery predicts postoperative intensive care unit length of stay (ICU LOS). Design: Retrospective case series. Setting: University-affiliated medical center. Patients: 103 adult ASA physical status I, II, and III patients undergoing spine surgery. Interventions: Patients were divided into three LOS groups: no ICU stay (LOS0) (n = 26), 1 day ICU stay (LOS1) (n = 48), and ICU stay > 1 day (LOS2) (n = 29). Measurements were analyzed by groups using the Kruskal-Wallis and Mann-Whitney tests, and linear regression. Measurements: Demographics, comorbidity, length of surgery, surgical procedure, and intraoperative fluids were recorded. Main Results: The important differences in perioperative fluid management among the three groups included estimated blood loss (612 ± 480 mL, 1853 ± 1175 mL, 2702 ± 1771 mL, means ± SD); total crystalloid administration (2715 ± 1396 mL, 5717 ± 2574 mL, 7281 ± 3417 mL); and total blood administration (92 ± 279 mL, 935 ± 757 mL, 1542 ± 1230 mL) in LOS0, LOS1, and LOS2, respectively. The mixture of surgical procedures was similar in LOS1 and LOS2; and differed from LOS0. Predictors of ICU LOS included age, ASA physical status, surgical procedure, total crystalloid administration, and platelet administration. Surgical procedure and total crystalloid administration correlated (Pearson correlation coefficient = 0.441; p = 0.000) and were not related to age or ASA physical status. Conclusions: Total crystalloid administration during spine surgery does predict ICU LOS. In addition, total crystalloid administration is closely related to the surgical procedure. Given that the mixture of surgical procedures was similar in LOS1 and LOS2, but differed in estimated blood loss, total crystalloid administration, and total blood administration; intraoperative fluid management during spine surgery only predicts ICU LOS insofar as total crystalloid administration is related to the surgical procedure.