ArticleBrazilian journal of anesthesiology (Elsevier)
Clinical impact of extubation in the operating room after cardiac surgery: a retrospective analysis of a prospective registry.
Article in Brazilian journal of anesthesiology (Elsevier). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundThe practice of immediate extubation in the Operating Room (OR) after cardiac surgery involving cardiopulmonary bypass remains debated. Concerns persist regarding its safety profile compared to conventional fast-track weaning in the Intensive Care Unit (ICU).
methodsThis retrospective analysis of a prospective single-center registry included 846 adult patients undergoing isolated Coronary Artery Bypass Grafting (CABG) or Heart Valve Surgery (HVS). To rigorously account for indication bias, we employed a doubly robust estimation approach, combining Stabilized Inverse Probability of Treatment Weighting (SIPTW) with multivariable regression adjustment for residual confounding.
resultsOf the 846 patients, 115 (13.6%) were extubated in the OR and 731 (86.4%) in the ICU. The weighted analysis successfully balanced baseline characteristics. Extubation in the OR was associated with a significant reduction in 30-day mortality (adjusted Hazard Ratio [aHR = 0.16]; 95% CI 0.03-0.92; p = 0.040) and acute kidney injury (adjusted Odds Ratio [aOR = 0.55]; 95% CI 0.31-0.99; p = 0.046). Additionally, it reduced the likelihood of prolonged ICU stay (> 14 days) (aOR = 0.10; p = 0.032). Contrary to unadjusted analyses, there was no significant association with respiratory tract infection (p = 0.163), reintubation (p = 0.103), or other adverse events.
conclusionIn this single-center, robustly adjusted analysis, extubation in the OR was associated with favorable outcomes, including lower 30-day mortality and reduced resource utilization in highly selected patients. Previous concerns regarding increased reintubation rates were not substantiated.
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