Association between early extubation and post-operative reintubation after elective open-heart surgery: a bi-institutional study

Abstract Objective It is unknown if remaining intubated after cardiac surgery is associated with a decreased risk of postoperative reintubation. The primary objective of this study was to investigate whether there is an association between the timing of extubation and the risk of reintubation after cardiac surgery. Design A retrospective, observational study. Setting Two university affiliated tertiary care centers. Participants 9,517 patients undergoing either isolated coronary artery bypass grafting (CABG) or aortic valve replacement (AVR). Intervention None Measurements and Main Results A total of 6,609 isolated CABGs and 2,908 isolated AVRs were performed during the study period. Reintubation occurred in 112 patients (1.64%) after CABG and 44 patients (1.5%) after AVR. After multivariable logistic regression analysis, early extubation (within the first 6 post-operative hours) was not associated with risk of reintubation after CABG (OR 0.53, 95% CI 0.26-1.06) and AVR (OR 0.52, 95% CI 0.22-1.22). Risk factors for reintubation included increased age in both the CABG (OR per 10 year increase, 1.63; 95% CI, 1.28-2.08) and AVR (OR per 10 year increase, 1.50; 95% CI, 1.12-2.01) cohorts. Total bypass time, race, and New York Heart Association (NYHA) functional class were not associated with reintubation risk. Conclusion Reintubation after CABGs and AVRs is a rare event, and advanced age is an independent risk factor. Risk is not increased with early extubation. This temporal association and low overall rate of reintubation suggest the strategies for extubation should be modified in this patient population.