Operating room extubation: A predictive factor for 1-year survival after double-lung transplantation.

Abstract BACKGROUND Operating room (OR) extubation has been reported after lung transplantation (LT) in small cohorts. This study aimed to evaluate the prognosis of OR-extubated patients. The secondary objectives were to evaluate the safety of this approach and to identify its predictive factors. METHODS This retrospective single-center cohort study included patients undergoing double lung transplantation (DLT) from January 2012 to June 2019. Patients undergoing multiorgan transplantation, repeat transplantation, or cardiopulmonary bypass during the study period were excluded. OR-extubated patients were compared with intensive care unit (ICU)-extubated patients. RESULTS Among the 450 patients included in the analysis, 161 (35.8%) were extubated in the OR, and four were reintubated within 24 hours. Predictive factors for OR extubation were chronic obstructive pulmonary disease (COPD)/emphysema (p=0.002) and cystic fibrosis (p=0.005), recipient body mass index (p=0.048), and the PaO2/FiO2 ratio 10 minutes after second graft implantation (p CONCLUSIONS OR extubation was associated with a favorable prognosis after DLT, but the association should not be interpreted as causality. This fast-track protocol was made possible by a team committed to developing a comprehensive strategy to enhance recovery.