Safety and efficacy of early extubation of elderly coronary artery bypass surgery patients.
OBJECTIVE
Early extubation and fast-track management protocols on younger, low-risk patients result in shorter hospital stays and decreased costs. The impact of such protocols on elderly patients undergoing coronary artery bypass graft (CABG) surgery is not presently known.


METHODS
A matched retrospective cohort study.


METHODS
A university teaching hospital.


METHODS
Six hundred ninety-eight consecutive patients undergoing isolated CABG between January 1995 and September 1996.


METHODS
Three hundred seventy-seven patients underwent early extubation, defined as extubation within 8 hours of arrival in the intensive care unit. They were divided into groups of patients 70 years of age and younger (n = 263) and patients older than 70 years of age (n = 114).


RESULTS
The mean length of stay (LOS) for all patients extubated within 8 hours or less was 5.5 days versus 8.4 days for patients who underwent later extubation (p < 0.0001). The percentage of patients undergoing early extubation was greater for the younger cohort (59% v 48%; p < 0.003) compared with the older cohort of patients. Analysis of demographics showed the older patients to have a greater incidence of peripheral vascular disease, congestive heart failure, and prior strokes (p < 0.05). Although the intensive care unit LOS was similar, postoperative LOS was 5.3 +/- 1.8 days for the younger patients versus 6.1 +/- 2.6 days for the older patients (p = 0.001). The overall surgical mortality rate was 2.6% (18/698), and there were no deaths among patients undergoing early extubation. Reintubation rate was negligible in both groups of patients.


CONCLUSIONS
This study confirms the safety and efficacy of early extubation among elderly patients undergoing CABG. Elderly patients have more comorbid conditions, yet a significant number can be extubated early, with resultant shortened LOSs.
Division of Cardiothoracic Surgery and Anesthesia, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, OH 44106, USA.
J H
JH
Lee
R
R
Graber
C G
CG
Popple
E
E
Furey
T
T
Lyons
H K
HK
Murrell
A S
AS
Geha
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000150:complications; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003422:Critical Care; D003710:Demography; D017048:Health Care Costs; D006333:Heart Failure / Q000150:complications; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome