Balancing intubation time with postoperative risk in cardiac surgery patients - a retrospective cohort analysis

• Published in: Therapeutics and clinical risk management Vol. 14; pp. 2203 - 2212
• Main Authors: Kotfis, Katarzyna, Szylińska, Aleksandra, Listewnik, Mariusz, Lechowicz, Kacper, Kosiorowska, Monika, Drożdżal, Sylwester, Brykczyński, Mirosław, Rotter, Iwona, Żukowski, Maciej
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2018; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Anesthesia; Anesthesiology; Bioethics; Body mass index; CABG; Cardiac arrhythmia; Cardiac patients; cardiac surgery; Cardiovascular disease; Clinical outcomes; Cohort analysis; complications; Coronary artery bypass; Coronary vessels; Delirium; Health aspects; Heart failure; Heart surgery; Hospital patients; Hospitals; Intensive care; Intubation; Kidneys; Morbidity; Mortality; Original Research; Patient safety; Physiological aspects; Postoperative complications; Regression analysis; Risk assessment; Smoking cessation; Stroke; Surgery; Systematic review; Ventilators; Poland; mortality; cardiac surgery; intubation; complications; CABG; delirium
• ISSN: 1176-6336; 1178-203X; 1178-203X
• DOI: 10.2147/TCRM.S182333

Intubation time in patients undergoing cardiac surgery may be associated with increased mortality and morbidity. Premature extubation can have serious adverse physiological consequences. The aim of this study was to determine the influence of intubation time on morbidity and mortality in patients undergoing cardiac surgery. We performed a retrospective analysis of data on 1,904 patients undergoing isolated coronary artery bypass grafting (CABG) and stratified them by duration of intubation time after surgery - 0-6, 6-9, 9-12, 12-24 and over 24 hours. Postoperative complications risk analysis was performed using multivariate logistic regression analysis for patients extubated ≤12 and >12 hours. Intubation percentages in each time cohort were as follows: 0-6 hours - 7.8%, 6-9 hours - 17.3%, 9-12 hours - 26.8%, 12-24 hours - 44.4% and >24 hours - 3.7%. Patients extubated ≤12 hours after CABG were younger, mostly males, more often smokers, with lower preoperative risk. They had lower 30-day mortality (2.02% vs 4.59%, =0.002), shorter hospital stay (7.68±4.49 vs 9.65±12.63 days, <0.001) and shorter intensive care unit stay (2.39 vs 3.30 days, <0.001). Multivariate analysis showed that intubation exceeding 12 hours after CABG increases the risk of postoperative delirium (OR 1.548, 95% CI 1.161-2.064, =0.003) and risk of postoperative hemofiltration (OR 1.302, 95% CI 1.023-1.657, =0.032). Results indicate that risk of postoperative complications does not increase until intubation time exceeds 12 hours. Shorter intubation time is seen in younger, men and smokers. Intubation time >12 hours is a risk factor for postoperative delirium and hemofiltration after cardiac surgery.