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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.

Files

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Also Published In

Title
The Annals of Thoracic Surgery
DOI
https://doi.org/10.1016/j.athoracsur.2019.04.013

More About This Work

Academic Units
Anesthesiology
Epidemiology
Published Here
June 3, 2019

Notes

This is an accepted manuscript to be published in The Annals of Thoracic Surgery, May 2019.

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