126 Can Patients on Ventilators Survive the Cut? A National Analysis of Surgery for Metastatic Spine Tumors

INTRODUCTION: Surgical intervention for metastatic spine tumors is often pursued to alleviate neurological compromise and improve quality of life. However, preoperative ventilator dependency may portend a worse prognosis. METHODS: Using the ACS NSQIP database (2007–2021), we identified 3,120 adult patients who underwent surgery for metastatic spine tumors. Of these, 23 (0.7%) were ventilator-dependent preoperatively, while 3,097 (99.3%) were not. Demographics, perioperative characteristics, and 30-day outcomes were analyzed using t-tests, univariate analysis, and multivariate logistic regression. RESULTS: The cohort was 41.1% female with a mean age of 62.3 ± 12.7 years. Mean operative time was 3.77 ± 2.03 hours and mean length of stay (LOS) was 10.2 ± 8.1 days. Ventilator-dependent patients had significantly longer hospital length of stay (15 ± 9 days vs. 10 ± 8 days, p<0.001). Univariate analysis showed ventilator dependency was associated with higher rates of failure to wean off the ventilator after 48 hours (26.1% vs. 1.7%, p<0.001), postoperative renal failure (4.3% vs. 0.1%, p=0.022), transfusion requirement (65.2% vs. 33.3%, p=0.001), septic shock (8.7% vs. 1.0%, p=0.024), reoperation (26.1% vs. 6.5%, p=0.003), and 30-day mortality (21.7% vs. 6.5%, p=0.007). Multivariate analysis that controlled for all statistically and clinically significant confounders, ventilator dependency independently predicted higher 30-day complication rates (82.6% vs. 43.6%, OR 7.1, 95% CI 1.52-33.24, p=0.013). CONCLUSIONS: Preoperative ventilator dependency is a strong independent predictor of increased postoperative morbidity and mortality in patients undergoing surgery for metastatic spine tumors. These findings underscore the need for increased perioperative vigilance and may inform risk stratification, shared decision-making, and the development of tailored prehabilitation protocols in this high-risk subgroup.