2019 Articles

Association of Overnight Extubation with Outcomes after Cardiac Surgery in the Intensive Care Unit

Gershengorn, Hayley; Wunsch, Hannah; Hua, May; Bavaria, Joseph E.; Gutsche, Jacob

Background
The frequency and safety of overnight extubation (OE) following cardiac surgery across intensive care units (ICUs) is unknown.

Methods
We performed a retrospective study of adults (≥18 years) in US ICUs following coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) using the Society of Thoracic Surgery Adult Cardiac Surgery Database (July 2014-June 2017); our primary cohort was elective CABGs. We assessed OE (7:00pm–6:59am) frequency and used multilevel regression modelling to identify factors associated with OE. Within mechanical ventilation (MV) duration strata, we used propensity-score matching to evaluate associations of OE with reintubations (primary outcome), mortality, and complications.

Results
Among 142,225 elective CABG patients, 42.2% were OEs. MV duration, cardiopulmonary bypass time, distal anastomosis number, and hospital of admission (median Odds Ratio (OR) (95% CI): 1.82 (1.76-1.89)) were independently associated with OE. After propensity matching, OE was associated with increased reintubation for MV duration 6-8h (2.2% vs 1.7%, OR: 1.27 (1.04,1.56)) and decreased reintubation for MV duration 15-17h (3.0% vs 4.2%, OR: 0.70 (0.50,0.97)) and 18-20h (2.3% vs 5.7%, OR: 0.39 (0.21,0.72)) patients; OE was associated with increased ICU length of stay for MV duration 6-8h, but reduced length of stay for MV duration 9-20h patients. OE was not associated with increased mortality (hospital, 30-day). Other groups had similar OE rates (non-elective CABGs, 47.6%; elective AVR, 36.0%; elective CABG+AVRs, 51.0%) and outcomes.

Conclusions
OE is prevalent following cardiac surgery. OE is associated with little risk and reduces ICU length of stay for those requiring MV for >8h.