• J. Cardiothorac. Vasc. Anesth. · May 2022

    Observational Study

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

    • Ethan Y Brovman, George Tolis, Sameer Hirji, Andrea Axtell, Kara Fields, J Daniel Muehlschlegel, Richard D Urman, Gaston A Cudemis Deseda, Tsuyoshi Kaneko, and Sergey Karamnov.
    • Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
    • J. Cardiothorac. Vasc. Anesth. 2022 May 1; 36 (5): 1258-1264.

    ObjectiveIt 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.DesignA retrospective, observational study.SettingTwo university-affiliated tertiary care centers.ParticipantsA total of 9,517 patients undergoing either isolated coronary artery bypass grafting (CABG) or aortic valve replacement (AVR).InterventionsNone.Measurements And Main ResultsA 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.ConclusionReintubation 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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