Quality improvement program increases early tracheal extubation rate and decreases pulmonary complications and resource utilization after cardiac surgery.
BACKGROUND
Early tracheal extubation is a common goal after cardiac surgery and may improve postoperative outcomes. Our study evaluates the impact of a quality improvement program (QIP) on early extubation, pulmonary complications, and resource utilization after cardiac surgery.


METHODS
Between 2002 and 2006, 980 patients underwent early tracheal extubation (<6 hours after surgery) and 1231 had conventional extubation (> 6 hours after surgery, conventional group). Outcomes compared between the two groups included: (1) pneumonia, (2) sepsis, (3) intensive care unit (ICU) length of stay, (4) hospital length of stay, (5) ICU readmission, and (6) reintubation. Logistic regression analysis and propensity score adjustment were used to adjust for imbalances in the patients' preoperative characteristics.


RESULTS
Early extubation rates were significantly increased with QIP (QIP 53% vs. Non-QIP 38%, p = 0.01). Early extubation was associated with a lower rate of (1) pneumonia (odds ratio [OR]= 0.35, 95% confidence intervals [CI]= 0.22-0.55, p <0.001), (2) sepsis (OR = 0.38, CI = 0.20-0.74, p <0.004), (3) prolonged ICU length of stay (OR = 0.42, CI = 0.35-0.50, p <0.001), (4) hospital length of stay (OR = 0.37, CI = 0.29-0.47, p <0.001), (5) ICU readmission (OR = 0.55, CI = 0.39-0.78, p <0.001), and (6) reintubation (OR = 0.53, CI = 0.34-0.81, p <0.003) both in multivariable logistic regression analysis and propensity score adjustment.


CONCLUSIONS
QIP and early tracheal extubation reduce pulmonary complications and resource utilization after cardiac surgery.
Camp
Sara L
SL
Department of Thoracic and Cardiovascular Surgery, Carolinas Heart and Vascular Institute, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA.
Stamou
Sotiris C
SC
Stiegel
Robert M
RM
Reames
Mark K
MK
Skipper
Eric R
ER
Madjarov
Jeko
J
Velardo
Bernard
B
Geller
Harley
H
Nussbaum
Marcy
M
Geller
Rachel
R
Robicsek
Francis
F
Lobdell
Kevin W
KW
D001026:Coronary Artery Bypass; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina; D010359:Patient Readmission / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011785:Quality Assurance, Health Care; D018805:Sepsis / Q000453:epidemiology; D013997:Time Factors