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Routine Extubation in the Operating Room After Isolated Coronary Artery Bypass.
James, Les; Smith, Deane E; Galloway, Aubrey C; Paone, Darien; Allison, Michael; Shrivastava, Shashwat; Vaynblat, Mikhail; Swistel, Daniel G; Loulmet, Didier F; Grossi, Eugene A; Williams, Mathew R; Zias, Elias.
Afiliación
  • James L; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Smith DE; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Galloway AC; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York. Electronic address: aubrey.galloway@nyulangone.org.
  • Paone D; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Allison M; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Shrivastava S; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Vaynblat M; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Swistel DG; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Loulmet DF; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Grossi EA; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Williams MR; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
  • Zias E; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
Ann Thorac Surg ; 117(1): 87-94, 2024 Jan.
Article en En | MEDLINE | ID: mdl-37806334
BACKGROUND: The benefits of fast-track extubation in the intensive care unit (ICU) after cardiac surgery are well established. Although extubation in the operating room (OR) is safe in carefully selected patients, widespread use of this strategy in cardiac surgery remains unproven. This study was designed to evaluate perioperative outcomes with OR vs ICU extubation in patients undergoing nonemergency, isolated coronary artery bypass grafting (CABG). METHODS: The Society of Thoracic Surgeons (STS) data for all single-center patients who underwent nonemergency isolated CABG over a 6-year interval were analyzed. Perioperative morbidity and mortality with ICU vs OR extubation were compared. RESULTS: Between January 1, 2017 and December 31, 2022, 1397 patients underwent nonemergency, isolated CABG; 891 (63.8%) of these patients were extubated in the ICU, and 506 (36.2%) were extubated in the OR. Propensity matching resulted in 414 pairs. In the propensity-matched cohort, there were no differences between the 2 groups in incidence of reintubation, reoperation for bleeding, total operative time, stroke or transient ischemic attack, renal failure, or 30-day mortality. OR-extubated patients had shorter ICU hours (14 hours vs 20 hours; P < .0001), shorter postoperative hospital length of stay (3 days vs 5 days; P < .0001), a greater likelihood of being discharged directly to home (97.3% vs 89.9%; P < .0001), and a lower 30-day readmission rate (1.7% vs 4.1%; P = .04). CONCLUSIONS: Routine extubation in the OR is a feasible and safe strategy for a broad spectrum of patients after nonemergency CABG, with no increase in perioperative morbidity or mortality. Wider adoption of routine OR extubation for nonemergency CABG is indicated.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Quirófanos / Extubación Traqueal Límite: Humans Idioma: En Revista: Ann Thorac Surg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Quirófanos / Extubación Traqueal Límite: Humans Idioma: En Revista: Ann Thorac Surg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos