• J H Lee, R Graber, C G Popple, E Furey, T Lyons, H K Murrell, and A S Geha.
• Division of Cardiothoracic Surgery and Anesthesia, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, OH 44106, USA.
• J. Cardiothorac. Vasc. Anesth. 1998 Aug 1; 12 (4): 381-4.

ObjectiveEarly extubation and fast-track management protocols on younger, low-risk patients result in shorter hospital stays and decreased costs. The impact of such protocols on elderly patients undergoing coronary artery bypass graft (CABG) surgery is not presently known.DesignA matched retrospective cohort study.SettingA university teaching hospital.ParticipantsSix hundred ninety-eight consecutive patients undergoing isolated CABG between January 1995 and September 1996.InterventionsThree hundred seventy-seven patients underwent early extubation, defined as extubation within 8 hours of arrival in the intensive care unit. They were divided into groups of patients 70 years of age and younger (n = 263) and patients older than 70 years of age (n = 114).ResultsThe mean length of stay (LOS) for all patients extubated within 8 hours or less was 5.5 days versus 8.4 days for patients who underwent later extubation (p < 0.0001). The percentage of patients undergoing early extubation was greater for the younger cohort (59% v 48%; p < 0.003) compared with the older cohort of patients. Analysis of demographics showed the older patients to have a greater incidence of peripheral vascular disease, congestive heart failure, and prior strokes (p < 0.05). Although the intensive care unit LOS was similar, postoperative LOS was 5.3 +/- 1.8 days for the younger patients versus 6.1 +/- 2.6 days for the older patients (p = 0.001). The overall surgical mortality rate was 2.6% (18/698), and there were no deaths among patients undergoing early extubation. Reintubation rate was negligible in both groups of patients.ConclusionThis study confirms the safety and efficacy of early extubation among elderly patients undergoing CABG. Elderly patients have more comorbid conditions, yet a significant number can be extubated early, with resultant shortened LOSs.

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