title: Routine operation theatre extubation after cardiac surgery in the elderly.
abstract: The aim was to analyse in-hospital outcomes of patients over 70 years of age undergoing routine immediate operation theatre (OT) extubation after on-pump or off-pump cardiac surgery.
  
  
  
  A retrospective analysis was performed of prospectively collected data over a 4-year period (2011-14) from elderly patients undergoing early extubation after cardiac surgery at a single institution. All patients over 70 years were considered eligible for immediate OT or intensive care unit (ICU) early extubation after meeting specific criteria. All types of non-emergency cardiac surgery were included. Cardiac surgical risk stratification was assessed with EuroSCORE II and age, creatinine level and left ventricular ejection fraction (ACEF) score.
  
  
  
  Among the 415 patients operated on during the period, 275 (66.3%) were ≥70 years old. One hundred and forty patients (50.9%) of the elderly group were extubated successfully in the OT. Excluding off-pump coronary surgery, OT extubation was achieved in 51.5% of cases. The rate of risk of reintubation within 24 h of surgery after OT extubation was 2.1%. The in-hospital mortality rate was 4.7%, and the complication rate was 11.6%, independently of extubation timing. Elderly patients extubated in the OT had a significantly lower median EuroSCORE II risk level and ACEF score, more isolated valve surgeries, reduced cardiopulmonary bypass time, less complications and shorter length of stay than ICU-extubated patients. In the multivariate analysis, only the ACEF score remained as an independent variable associated with OT extubation in the elderly (odds ratio 25.0, 95% CI 2.74-228.8, P = 0.004), and had good discriminating power [receiver operating characteristics (ROC) area 0.713]. On the other hand, the EuroSCORE ROC area used to predict OT extubation was 0.694, and the cut-off analysis showed that a risk value under 2.11 was associated with 72.1% OT extubation versus 37.3% when the risk value was over 2.11 (P = 0.0002).
  
  
  
  OT extubation in the elderly can be safely performed in nearly 50% of patients, without apparently worsening their outcomes. A key point of this success was the use of a short-acting volatile agent to maintain anaesthesia throughout the procedure. Low- or moderate-risk cardiac surgery assessed with a preoperative EuroSCORE II <2.11 will help to better predict successful OT extubation in the elderly.
authors.affiliation: Department of Cardiac Surgery, ENERI-Sagrada Familia Clinic, Buenos Aires, Argentina School of Medicine, Buenos Aires University, Buenos Aires, Argentina raborracci@gmail.com.
authors.forename: Raul A
authors.initials: RA
authors.lastname: Borracci
authors.affiliation: Department of Anesthesia, and Cardiology, ENERI-Sagrada Familia Clinic, Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Ochoa
authors.affiliation: Department of Cardiology, ENERI-Sagrada Familia Clinic, Buenos Aires, Argentina.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Ingino
authors.affiliation: Department of Cardiology, ENERI-Sagrada Familia Clinic, Buenos Aires, Argentina.
authors.forename: Janina M
authors.initials: JM
authors.lastname: Lebus
authors.affiliation: Department of Cardiology, ENERI-Sagrada Familia Clinic, Buenos Aires, Argentina.
authors.forename: Sabrina V
authors.initials: SV
authors.lastname: Grimaldi
authors.affiliation: Department of Cardiology, ENERI-Sagrada Familia Clinic, Buenos Aires, Argentina.
authors.forename: Maria X
authors.initials: MX
authors.lastname: Gambetta
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000379:methods* / Q000401:mortality; D001118:Argentina / Q000453:epidemiology; D006348:Cardiac Surgical Procedures; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016017:Odds Ratio; D009873:Operating Rooms; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors
keywords: Age; Cardiac anaesthesia; Cardiac surgery; Creatinine level; Early extubation; Elderly patients; EuroSCORE II; Left ventricular ejection fraction score; Length of stay; Operation theatre
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