title: Can timing of tracheal extubation predict improved outcomes after cardiac surgery?
abstract: BACKGROUND
  Early tracheal extubation is a common goal after cardiac surgery. Our study aims to examine whether timing of tracheal extubation predicts improved postoperative outcomes and late survival after cardiac surgery. We also evaluated the optimal timing of extubation and its association with better postoperative outcomes.
  
  
  METHODS
  Between 2002 and 2006, 1164 patients underwent early tracheal extubation (<6 hours after surgery) and 1571 had conventional extubation (>6 hours after surgery). Propensity score adjustment and multivariable logistic regression analysis were used to adjust for imbalances in the patients' preoperative characteristics. Receiver operating characteristic curves (ROC) were used to identify the best timing of extubation and improved postoperative outcomes. Cox regression analysis was used to identify whether early extubation is a risk factor for decreased late mortality.
  
  
  RESULTS
  Results - Early extubation was associated with lower propensity score-adjusted rate of operative mortality (Odds Ratio =0.55, 95% Confidence Intervals =0.31-0.98, p=0.043). Extubation within 9 hours emerged as the best predictor of improved postoperative morbidity and mortality (sensitivity =85.5%, specificity =52.7%, accuracy =64.5%). Early extubation also predicted decreased late mortality (Hazard Ratio =0.45, 95% Confidence Intervals 0.31-0.67, p<0.001).
  
  
  CONCLUSIONS
  Early extubation may predict improved outcomes after cardiac surgery. Extubation within 9 hours after surgery was the best predictor of uncomplicated recovery after cardiac surgery. Those patients intubated longer than 16 hours have a poorer postoperative prognosis. Early extubation predicts prolonged survival up to 16 months after surgery.
authors: Department of Thoracic and Cardiovascular Surgery, Carolinas Medical Center, Charlotte, North Carolina, US.
authors: S L
authors: SL
authors: Camp
authors: S C
authors: SC
authors: Stamou
authors: R M
authors: RM
authors: Stiegel
authors: M K
authors: MK
authors: Reames
authors: E R
authors: ER
authors: Skipper
authors: J
authors: J
authors: Madjarov
authors: B
authors: B
authors: Velardo
authors: H
authors: H
authors: Geller
authors: M
authors: M
authors: Nussbaum
authors: R
authors: R
authors: Geller
authors: F
authors: F
authors: Robicsek
authors: K W
authors: KW
authors: Lobdell
keywords: coronary artery bypass; early extubation; mortality