• Sara L Camp, Sotiris C Stamou, Robert M Stiegel, Mark K Reames, Eric R Skipper, Jeko Madjarov, Bernard Velardo, Harley Geller, Marcy Nussbaum, Rachel Geller, Francis Robicsek, and Kevin W Lobdell.
• Department of Thoracic and Cardiovascular Surgery, Carolinas Heart and Vascular Institute, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA.
• J Card Surg. 2009 Jul 1;24(4):414-23.

BackgroundEarly tracheal extubation is a common goal after cardiac surgery and may improve postoperative outcomes. Our study evaluates the impact of a quality improvement program (QIP) on early extubation, pulmonary complications, and resource utilization after cardiac surgery.MethodsBetween 2002 and 2006, 980 patients underwent early tracheal extubation (<6 hours after surgery) and 1231 had conventional extubation (> 6 hours after surgery, conventional group). Outcomes compared between the two groups included: (1) pneumonia, (2) sepsis, (3) intensive care unit (ICU) length of stay, (4) hospital length of stay, (5) ICU readmission, and (6) reintubation. Logistic regression analysis and propensity score adjustment were used to adjust for imbalances in the patients' preoperative characteristics.ResultsEarly extubation rates were significantly increased with QIP (QIP 53% vs. Non-QIP 38%, p = 0.01). Early extubation was associated with a lower rate of (1) pneumonia (odds ratio [OR]= 0.35, 95% confidence intervals [CI]= 0.22-0.55, p <0.001), (2) sepsis (OR = 0.38, CI = 0.20-0.74, p <0.004), (3) prolonged ICU length of stay (OR = 0.42, CI = 0.35-0.50, p <0.001), (4) hospital length of stay (OR = 0.37, CI = 0.29-0.47, p <0.001), (5) ICU readmission (OR = 0.55, CI = 0.39-0.78, p <0.001), and (6) reintubation (OR = 0.53, CI = 0.34-0.81, p <0.003) both in multivariable logistic regression analysis and propensity score adjustment.ConclusionsQIP and early tracheal extubation reduce pulmonary complications and resource utilization after cardiac surgery.

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