Cardiothoracic & vascular anesthesia
Safe Landing: Feasibility and Safety of Operating Room Extubation in Minimally Invasive Cardiac Valve Surgery
Main finding · Postoperative delirium (interrupted time series)Result — go to the resultRelative risk 0.37 CI 0.13–1.10Authors' conclusion
OR extubation was not associated with increased postoperative delirium or reintubation rates but did decrease intubation duration.
Study context
- Population
- Patients undergoing minimally invasive valvular surgery via thoracotomy (November 2017-October 2022), single US academic centre
- Participants
- 312 patients
- Exposure
- OR extubation protocol era vs pre-implementation era
- Intensive care unit (ICU) extubationn = 254reference
- OR extubationn = 58
- Outcome
- Delirium rates, reintubation rates and intubation duration before vs after OR extubation protocol implementation
Methodological detailssingle-centre, retrospective chart review, interrupted time series analysis, before-after
- Single-centre
- Retrospective chart review
- Interrupted time series analysis
- Before-after
Main finding
Postoperative delirium (interrupted time series)
Relative risk
0.37
CI 0.13–1.10
P = 0.07
Post-implementation vs Pre-implementation
RR 0.37 (CI 0.13–1.10); P = 0.07
As reported in the abstract
Observational data: associations, not effects.
Further findings
Median
| Outcome | ICU extubation | OR extubation | P value |
|---|---|---|---|
| Intubation durationPost-implementation vs Pre-implementation | P < 0.001 | ||
| Charlson Comorbidity Index (baseline) | 2.0 | 1.5 |
- Intubation duration: Post-implementation median 8 hours
- Intubation duration: Pre-implementation median 13 hours
Factors associated with OR extubation (logistic regression)
- Increased bypass length, OR
- 0.99 (CI 0.98-0.99, p < 0.001)
- Intraoperative MME, OR
- 0.99 (CI 0.99-1.0, p = 0.009)
- Preoperative Charlson Comorbidity Index above 3, OR
- 0.42 (CI 0.19-0.95, p = 0.037)
- Associated with decreased odds of OR extubation
Safety
Reintubation
P = 0.159
Original publication
Safe Landing: Feasibility and Safety of Operating Room Extubation in Minimally Invasive Cardiac Valve Surgery. J Cardiothorac Vasc Anesth. Published 19 September 2024. doi:10.
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