title: Feasibility and outcomes of an early extubation policy after esophagectomy.
abstract: BACKGROUND
  Although early extubation of esophagectomy patients has been found to be feasible, safe, and associated with low morbidity, there is no uniform standard of care among high volume centers. Our objective is to examine a contemporary series of esophagectomies and identify the feasibility and outcome of an early extubation policy.
  
  
  METHODS
  This study is a retrospective review of all patients who underwent esophagectomy between January 2003 and December 2004 at the Massachusetts General Hospital. One hundred and two patients were analyzed from 129 consecutive patients who underwent esophagectomy and subsequently divided in two groups: The early extubation group was extubated in the operating room and the late extubation group was extubated in the intensive care unit (ICU).
  
  
  RESULTS
  Ninety percent were extubated early. Although most patients underwent a transthoracic or thoracoabdominal esophagectomy, the operative approach did not influence failure to extubate. Neoadjuvant therapy was not predictive of extubation failure. Most patients age 70 or greater (86%) were extubated early. There were three nonelective reintubations in the early extubation group secondary to acute respiratory distress syndrome. The median length of stay was 11 days and median ICU stay was one day. The 30-day mortality was 1.9% and the median survival was 28 months.
  
  
  CONCLUSIONS
  Attention to restricted intraoperative fluid balance, limited blood loss, anesthetic technique, and epidural use permit most patients undergoing esophageal resection to be safely extubated immediately postresection in the operating room.
authors.affiliation: Division of General Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. mlanuti@partners.org
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.forename: Pierre E
authors.initials: PE
authors.lastname: de Delva
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Maher
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.forename: Dean M
authors.initials: DM
authors.lastname: Donahue
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D020878:Device Removal; D004935:Esophageal Diseases / Q000601:surgery; D016629:Esophagectomy; D005240:Feasibility Studies; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome