• Jonathan Gal, Samuel Hunter, David Reich, Eric Franz, Samuel DeMaria, Sean Neifert, Hung-Mo Lin, Xiaoyu Liu, John Caridi, and Daniel Katz.
• Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America. Electronic address: Jonathan.gal@mountsinai.org.
• J Clin Anesth. 2022 May 1; 77: 110636.

Study ObjectiveTo elucidate the association between delayed extubation, postoperative complications, and episode-based resource utilization.DesignRetrospective Propensity-Matched Cohort Study.SettingSingle Large Academic Medical Center.PatientsThe computerized anesthetic records of 17,223 patients undergoing spine surgery from January 2006 through November 2016 were reviewed for this study. The records of 11,421 patients met inclusion criteria for final analysis, with 527 subjects who had delayed extubation following their procedure.InterventionsDelayed extubation, defined as patients not extubated prior to leaving the operating room.MeasurementsComputerized anesthetic records of spine surgery patients were analyzed retrospectively. Corresponding Medicare Severity Diagnosis Related Group numbers (MS-DRGs) were then identified, as well as associated lengths of stay and costs of care. We compared hospital-acquired International Classification of Diseases-9 (ICD-9) and ICD-10 postoperative complication codes linked to each record to assess differences in outcome.Main ResultsIncreasing medical and surgical complexity is associated with delayed extubation. Using propensity score matching, delayed extubation was independently associated with a higher likelihood of any postoperative complication (Odds Ratio [OR]: 1.79; 95% Confidence Interval [CI]: 1.23-2.61); major complications (OR: 2.22; 95% CI: 1.31-3.76); prolonged length of hospital stay (Hazard Ratio [HR]: 0.82 (0.72, 0.95), p = 0.006); prolonged Intensive Care Unit (ICU) stay (HR: 0.68 (0.61, 0.76), p < 0.001); and were less likely to be discharged home (OR: 1.40 (1.02, 1.92), p = 0.036). Propensity score matching demonstrated that anesthesiologist handoff was not independently associated with any of the examined adverse outcomes.ConclusionsDelayed extubation after spine surgery was associated with a statistically significant increased incidence of postoperative complications as well as increased hospital episode-based resource utilization in the form of increased hospital length of stay, ICU length of stay, post-acute care at a facility, and higher cost of hospitalization. Although anesthesiologist handoff was associated with delayed extubation, it was not independently associated with postoperative complications when propensity score matching was applied.Published by Elsevier Inc.

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