title: Factors associated with and consequences of unplanned post-operative intubation in elderly vascular and general surgery patients.
abstract: OBJECTIVE
  Unplanned post-operative intubation (UPI) may be associated with significant morbidity and/or mortality after surgery. The purpose of this investigation was to determine the incidence and predictors of UPI in elderly patients who underwent general and vascular surgical procedures.
  
  
  METHODS
  Data from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File was used to calculate the incidence of UPI in all elderly vascular and general surgery patients undergoing operations from 2005 to 2008. UPI was defined as a requirement for the placement of an endotracheal tube and mechanical or assisted ventilation because of the onset of respiratory or cardiac failure manifested by severe respiratory distress, hypoxia, hypercarbia or respiratory acidosis within 30 days of the index operation. Univariate factors associated with UPI were identified. Multivariate stepwise logistic regression was used to calculate odds ratios (ORs) for UPI after controlling for known clinically relevant cofactors.
  
  
  METHODS
  Incidence of UPI as well as morbidity and mortality associated with UPI.
  
  
  RESULTS
  Among 115 692 patients, 3.3% required UPI. Univariate predictors of UPI were older age group, chronic obstructive pulmonary disease, low pre-operative functional status as well as emergency operation. UPI was associated with an 18-fold increased risk of death as well as significantly increased hospital length of stay. Multivariate analysis identified several predictors of UPI with re-operation having the greatest odds for UPI (OR = 4.5; 95% confidence interval = 4.29-4.86, P < 0.001).
  
  
  CONCLUSIONS
  Although the incidence of UPI in this elderly surgical cohort was low, it was associated with significant morbidity and mortality as well as prolonged hospital length of stay, underscoring the need for accurately identifying modifiable risk factors.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA. onafiu@med.umich.edu
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: Satya K
authors.initials: SK
authors.lastname: Ramachandran
authors.forename: Ray
authors.initials: R
authors.lastname: Ackwerh
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Tremper
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.forename: James C
authors.initials: JC
authors.lastname: Stanley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000379:methods*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods