title: Effect of differences in extubation timing on postoperative care following abdominal aortic replacement surgery: a comparison study.
abstract: BACKGROUND
  Abdominal aortic replacement requires an extensive incision and strict blood pressure control, making rapid extubation of the tracheal tube and pain management difficult. The effects of extubation timing on the postoperative course and medical costs in the intensive care unit (ICU) were analyzed.
  
  
  METHODS
  Patients who underwent elective abdominal aortic replacement were evaluated retrospectively. Patients were divided into those extubated on the day of surgery (Group A) and those extubated later (Group B). Group A was subdivided into extubation in the operating room (Group A1) or in the ICU (Group A2). Intubation time in the ICU, postoperative ICU stay, hospital stay, and total ICU expenses were compared among the four groups.
  
  
  RESULTS
  Of the 191 patients, 95 were extubated on the day of surgery (Group A) and 96 later (Group B). The two groups differed in age and percutaneous coronary intervention history. Surgery and anesthesia durations, intraoperative infusion volume, and intraoperative bleeding amounts differed significantly in the two groups. Epidural anesthesia was given more frequently in Group A. Mean intubation time in the ICU (2.6 ± 2.8 vs 17.4 ± 5.1 hours, P < 0.01), the ICU stay (2.1 ± 0.3 vs 2.4 ± 0.8 days, P < 0.01), and the hospital stay (16.4 ± 5.2 vs 20.2 ± 12.5 days, P = 0.02) were significantly shorter, and total ICU expenses were significantly lower (1,036 ± 307 vs 1,565 ± 1,072 dollars, P < 0.01), in Group A than in Group B. Of the 95 patients in Group A, 34 were extubated in the operating room (Group A1) and 61 in the ICU (Group A2). Arrhythmia, epidural anesthesia, and the amount of intraoperative infusion amount were significantly higher, and the percentage of women significantly lower, in Group A1 (vs Group A2). Postoperative ICU and hospital stays and the ICU costs were not significantly different.
  
  
  CONCLUSIONS
  Tracheal tube extubation on the day of abdominal aortic replacement surgery resulted in better postoperative course and lower costs than when extubation occurred later. Patients extubated in the operating room or the ICU on the day of surgery had similar postoperative courses and costs.
authors: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686 Japan.
authors: Naomi
authors: N
authors: Ono
authors: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686 Japan.
authors: Junko
authors: J
authors: Nakahira
authors: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686 Japan.
authors: Toshiyuki
authors: T
authors: Sawai
authors: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686 Japan.
authors: Yosuke
authors: Y
authors: Kuzukawa
authors: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686 Japan.
authors: Toshiaki
authors: T
authors: Minami
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000191:economics / Q000379:methods*; D000767:Anesthesia, Epidural / Q000191:economics; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000191:economics / Q000601:surgery*; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Abdominal aortic replacement surgery; Cost in intensive care unit; Timing of extubation