title: Variation in tracheal reintubations among patients undergoing cardiac surgery across Washington state hospitals.
abstract: OBJECTIVE
  The objectives of this study were to examine the variation in reintubations across Washington state hospitals that perform cardiac surgery, and explore hospital and patient characteristics associated with variation in reintubation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All nonfederal hospitals performing cardiac surgery in Washington state.
  
  
  METHODS
  A total of 15,103 patients undergoing coronary artery bypass grafting or valvular surgery between January 1, 2008 and September 30, 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patient and hospital characteristics were compared between hospitals that had a reintubation frequency ≥5% or<5%. Multivariate logistic regression was used to compare the odds of reintubation across the hospitals. The authors tested for heterogeneity of odds of reintubation across hospitals by performing a likelihood ratio test on the hospital factor. After adjusting for patient-level characteristics and procedure type, significant heterogeneity in reintubations across hospitals was present (p = 0.005). This exploratory analyses suggested that hospitals with lower reintubations were more likely to have more acute care days and teaching intensive care units (ICU).
  
  
  CONCLUSIONS
  After accounting for patient and procedure characteristics, significant heterogeneity in the relative odds of requiring reintubation was present across 16 nonfederal hospitals performing cardiac surgery in Washington state. The findings suggested that greater hospital volume and ICU teaching status were associated with fewer reintubations.
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington. Electronic address: khandel@uw.edu.
authors: Nita
authors: N
authors: Khandelwal
authors: Division of Pulmonary and Critical Care Medicine, Swedish Medical Center, Seattle, Washington.
authors: Christopher R
authors: CR
authors: Dale
authors: Center for Biomedical Statistics.
authors: David C
authors: DC
authors: Benkeser
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington.
authors: Aaron M
authors: AM
authors: Joffe
authors: Center for Biomedical Statistics.
authors: Norbert David
authors: ND
authors: Yanez
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
authors: Miriam M
authors: MM
authors: Treggiari
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation; D058109:Airway Management / Q000009:adverse effects / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003422:Critical Care / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006306:Health Surveys; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014861:Washington
keywords: cardiac surgery; critical care; extubation failure; outcomes; reintubation