Association Between Early Extubation and Postoperative Reintubation After Elective Cardiac Surgery: A Bi-institutional Study

• Published in: Journal of cardiothoracic and vascular anesthesia 2022-05, Vol.36 (5), p.1258-1264
• Main Authors: Brovman, Ethan Y., Tolis, George, Hirji, Sameer, Axtell, Andrea, Fields, Kara, Muehlschlegel, J. Daniel, Urman, Richard D., Deseda, Gaston A. Cudemis, Kaneko, Tsuyoshi, Karamnov, Sergey
• Format: Article
• Language: English
• Subjects: Airway Extubation - adverse effects; Aortic Valve - surgery; aortic valve replacement; cardiac anesthesia; Cardiac Surgical Procedures - adverse effects; Coronary Artery Bypass - adverse effects; coronary artery bypass grafting; extubation; Heart Valve Prosthesis Implantation - adverse effects; Humans; reintubation; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2021.11.027

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. A retrospective, observational study. Two university-affiliated tertiary care centers. A total of 9,517 patients undergoing either isolated coronary artery bypass grafting (CABG) or aortic valve replacement (AVR). None. 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. 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.