Timing and Incidence of Airway Interventions Following Occipitocervical Fusion: A Retrospective Study Using the Nationwide Inpatient Sample 2017 to 2022

BACKGROUND: Occipitocervical fusions (OCFs) are associated with adverse airway events. The period of airway compromise remains poorly defined. The objective of this study was to identify differences between OCF and posterior cervical fusion not involving the occipitocervical joint (NOCF) in the timing and incidence of postoperative airway interventions. METHODS: Using the 2017 to 2022 Nationwide Inpatient Sample, we identified 1908 OCF and 38,743 NOCF hospitalizations (excluding anterior surgeries and spinal cord injury at or above C5). Survey‑weighted logistic regression and competing‑risks analysis were used to assess the incidence and temporal patterns of postoperative airway instrumentation. RESULTS: OCF was associated with higher odds of tracheostomy (6.34% vs. 1.35%; adjusted OR=2.42; 95% CI: 1.92-3.05; P<0.001) and reintubation (2.10% vs. 0.78%; OR=1.54; 95% CI: 1.09-2.19; P=0.015) overall. On qualitative assessment of cumulative incidence curves, OCF demonstrated a distinct temporal crossover: tracheostomies exceeded reintubations by POD 3. Reintubation leveled off near the second postoperative week after OCF compared with the first week after NOCF, while tracheostomy placement leveled off around the third week after OCF compared with the second week after NOCF. The weighted 30-day cumulative incidence of tracheostomy was 5.31% for OCF versus 1.22% for NOCF (Gray P<0.001), and for reintubation it was 2.10% versus 0.77% (Gray P<0.001), with death and discharge as competing events. CONCLUSION: Following OCF, postoperative tracheostomies and reintubations occur more frequently and over a more prolonged postoperative period compared with NOCF. By POD 3, tracheostomies were performed more frequently than reintubations in OCF.