Nguyen Q, Coghlan K, Hong Y, Nagendran J, MacArthur R, Lam W. Factors Associated With Early Extubation After Cardiac Surgery: A Retrospective Single-Center Experience.
J Cardiothorac Vasc Anesth 2020;
35:1964-1970. [PMID:
33414072 DOI:
10.1053/j.jvca.2020.11.051]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES
To identify factors associated with early extubation in cardiac surgery patients.
DESIGN
Single center, retrospective.
SETTING
Tertiary university hospital.
PARTICIPANTS
The study comprised 8,872 adult patients who underwent cardiothoracic surgery from 2011-2019.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Of the 8,872 patients, 2,950 (33%) were extubated within six hours after surgery. Early extubated patients were younger, had a higher body mass index (BMI), were more likely to be male, and were fast-track designated. These patients more frequently underwent isolated coronary artery bypass graft, isolated valve, or adult congenital surgeries than did late extubated patients. Early extubated patients had a greater incidence of coronary artery disease (CAD) and anxiety and a higher left ventricular ejection fraction. They also were less likely to have difficult intubation or require mechanical circulatory support, reintubation, or readmission. Analysis of the 8,872 patients showed that male sex (odds ratio [OR] 1.222, 95% confidence interval [CI] 1.096-1.363), a BMI >30 kg/m2 (OR 1.702, 95% CI 1.475-1.965), undergoing isolated valve surgery (OR 1.187, 95% CI 1.060-1.328), and having a fast-track designation (OR 1.455, 95% CI 1.208-1.751) and CAD (OR 1.122, 95% CI 1.005-1.253) were associated with early extubation. Data on intensive care unit (ICU) admission after surgery were available only from 2014-2018. Within this subgroup of 5,977 patients, variables associated with early extubation included male sex (OR 1.356, 95% CI 1.193-1.541), BMI >30 kg/m2 (OR 1.267, 95% CI 1.084-1.480), daytime admission to the ICU (OR 1.712, 95% CI 1.527-1.919), and fast-track designation (OR 1.423, 95% CI 1.123-1.802).
CONCLUSIONS
Male sex; a BMI >30 kg/m2; undergoing isolated valve surgery; and having a fast-track designation, CAD, and daytime admission to the ICU are associated with early extubation.
Collapse