Association Between Early Extubation and Postoperative Reintubation After Elective Cardiac Surgery: A Biinstitutional Study

Published:November 26, 2021DOI:https://doi.org/10.1053/j.jvca.2021.11.027

      Objective

      It is unknown if remaining intubated after cardiac surgery is associated with a decreased risk of postoperative reintubation. The primary objective of this study was to investigate whether there was an association between the timing of extubation and the risk of reintubation after cardiac surgery.

      Design

      A retrospective, observational study.

      Setting

      Two university-affiliated tertiary care centers.

      Participants

      A total of 9,517 patients undergoing either isolated coronary artery bypass grafting (CABG) or aortic valve replacement (AVR).

      Interventions

      None.

      Measurements and Main Results

      A total of 6,609 isolated CABGs and 2,908 isolated AVRs were performed during the study period. Reintubation occurred in 112 patients (1.64%) after CABG and 44 patients (1.5%) after AVR. After multivariate logistic regression analysis, early extubation (within the first 6 postoperative hours) was not associated with a risk of reintubation after CABG (odds ratio [OR] 0.53, 95% CI 0.26-1.06) and AVR (OR 0.52, 95% CI 0.22-1.22). Risk factors for reintubation included increased age in both the CABG (OR per 10-year increase, 1.63; 95% CI 1.28-2.08) and AVR (OR per 10-year increase, 1.50; 95% CI 1.12-2.01) cohorts. Total bypass time, race, and New York Heart Association (NYHA) functional class were not associated with reintubation risk.

      Conclusion

      Reintubation after CABGs and AVRs is a rare event, and advanced age is an independent risk factor. Risk is not increased with early extubation. This temporal association and low overall rate of reintubation suggest the strategies for extubation should be modified in this patient population.

      Key Words

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      Linked Article

      • Early But Prudent
        Journal of Cardiothoracic and Vascular Anesthesia
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          WE READ with interest the recent study by Brovman et al describing fast-track protocols in cardiac anesthesia.1 The authors concluded that early extubation does not entail significant reintubation risk following coronary artery bypass grafting (CABG) and aortic valve replacement (AVR), as they achieved an early extubation in 34.5% of CABG and 47.7% of AVR patients.1 A thorough evaluation of comorbidities may have provided useful insights into the ability to perform successful early extubation.1,2 The European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was not included in the index analysis, the importance of the former being emphasized by Shoji et al.
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