TY - JOUR
T1 - A retrospective multicenter study of operating room extubation and extubation timing after cardiac surgery
AU - IMPROVE Network
AU - Etchill, Eric W.
AU - Wu, Xiaoting
AU - Alejo, Diane
AU - Fonner, Clifford E.
AU - Ling, Carol
AU - Worrall, Neil
AU - Lehr, Eric
AU - Pagani, Francis
AU - Haber, Terri
AU - Theurer, Patty
AU - Collins-Brandon, Jeannie
AU - Hira, Ravi
AU - Brevig, James
AU - Mallory, Erika
AU - Maynard, Charles
AU - Likosky, Donald S.
AU - Whitman, Glenn J.R.
N1 - Publisher Copyright:
© 2024 The American Association for Thoracic Surgery
PY - 2024
Y1 - 2024
N2 - Background: In an effort to enhance recovery after cardiac surgery, intraoperative extubation has been targeted as possibly beneficial. This multicenter cohort study aimed to assess this by evaluating the outcomes of operating room (OR) extubation versus extubation within 6 hours of intensive care unit (ICU) arrival (early ICU extubation). Furthermore, we assessed time to ICU extubation and mortality and morbidity. Methods: Patients undergoing on-pump cardiac surgery across 79 hospitals between 2011 and 2020 were included to (1) compare outcomes among OR extubation and early ICU extubation patients and (2) assess time to overall ICU extubation and outcomes. Results: The overall study cohort comprised 163,982 patients, including 95,982 patients (OR extubation: n = 2529 [2.6%] and early ICU extubation: n = 93,453 [97.4%]) who underwent comparison of OR with early ICU extubation. After overlap weighting, patients with OR extubation had longer OR times (5.6 vs 5.1 hours, P <. 0001) and greater rates of reintubation (5.2% vs 2.9%, P = .003), prolonged ventilation (3% vs 2%, P = .021), reoperation for bleeding (1.5% vs 0.7%, P < .01), pneumonia (1.9% vs 1.1%, P < .006), and greater in-hospital mortality on multivariable regression (odds ratio, 1.34, P < .001). Patients with OR extubation at centers with low OR extubation rates (<10%, n = 60) had greater mortality (odds ratio, 1.6, P = .001). Beyond 22 hours of postoperative ICU ventilation, the risk of morbidity and mortality increased significantly. Conclusions: Few patients who undergo cardiac surgery are extubated in the OR, which is associated with no clinical benefit and with increased morbidity. Cardiac surgery programs should reconsider OR extubation after cardiopulmonary bypass. In addition, increased intubation time, in particular >22 hours, is associated with an increase in adverse outcomes.
AB - Background: In an effort to enhance recovery after cardiac surgery, intraoperative extubation has been targeted as possibly beneficial. This multicenter cohort study aimed to assess this by evaluating the outcomes of operating room (OR) extubation versus extubation within 6 hours of intensive care unit (ICU) arrival (early ICU extubation). Furthermore, we assessed time to ICU extubation and mortality and morbidity. Methods: Patients undergoing on-pump cardiac surgery across 79 hospitals between 2011 and 2020 were included to (1) compare outcomes among OR extubation and early ICU extubation patients and (2) assess time to overall ICU extubation and outcomes. Results: The overall study cohort comprised 163,982 patients, including 95,982 patients (OR extubation: n = 2529 [2.6%] and early ICU extubation: n = 93,453 [97.4%]) who underwent comparison of OR with early ICU extubation. After overlap weighting, patients with OR extubation had longer OR times (5.6 vs 5.1 hours, P <. 0001) and greater rates of reintubation (5.2% vs 2.9%, P = .003), prolonged ventilation (3% vs 2%, P = .021), reoperation for bleeding (1.5% vs 0.7%, P < .01), pneumonia (1.9% vs 1.1%, P < .006), and greater in-hospital mortality on multivariable regression (odds ratio, 1.34, P < .001). Patients with OR extubation at centers with low OR extubation rates (<10%, n = 60) had greater mortality (odds ratio, 1.6, P = .001). Beyond 22 hours of postoperative ICU ventilation, the risk of morbidity and mortality increased significantly. Conclusions: Few patients who undergo cardiac surgery are extubated in the OR, which is associated with no clinical benefit and with increased morbidity. Cardiac surgery programs should reconsider OR extubation after cardiopulmonary bypass. In addition, increased intubation time, in particular >22 hours, is associated with an increase in adverse outcomes.
KW - cardiac surgery
KW - critical care
KW - early extubation
KW - enhanced recovery after surgery
KW - extubation timing
KW - operating room extubation
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U2 - 10.1016/j.jtcvs.2024.09.057
DO - 10.1016/j.jtcvs.2024.09.057
M3 - Article
C2 - 39426716
AN - SCOPUS:85209259812
SN - 0022-5223
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
ER -