title: Factors Associated with Safe Extubation in the Operating Room After On-Pump Cardiac Valve Surgery.
abstract: BACKGROUND
  Extubation in the operating room (OR) after cardiac surgery remains controversial due to safety concerns. Its feasibility had been suggested in select patients after off-pump surgery.
  
  
  OBJECTIVE
  To review the outcomes of patients extubated in the OR after on-pump cardiac valve surgery (cohort of interest) in comparison with patients extubated conventionally in the intensive care unit (ICU) (control). We hypothesized that the timing of extubation was not associated with postoperative complications.
  
  
  METHODS
  Retrospective review of 272 consecutive patients who had undergone cardiac valve surgery at Jackson Memorial Hospital, Miami, Florida between January 1, 2009 and December 30, 2013.
  
  
  RESULTS
  Compared with the control group, patients extubated in the OR had shorter cardiopulmonary bypass (CPB) (87 vs. 113 min, p < 0.0001) and aortic cross-clamp times (60 vs. 78 min, p < 0.0001), lower transfusion requirements (41.38% vs. 57.01%, p = 0.0342), shorter ICU (four vs. five days, p = 0.0002), and hospital stays (7.8 vs. 10 days, p = 0.0151). Mortality, overall rates of complications in all categories, ICU readmissions, and reintubations were similar in both groups. Each additional minute of CPB decreased the odds of extubation in the OR by a factor of 0.988 (odds ratio = 0.988; 95%CI: 0.980, 0.997). Pulmonary perfusion and ventilation during CPB increased the likelihood of extubation in the OR by a factor of 2.45 (odds ratio = 2.453; 95%CI: 1.247, 4.824).
  
  
  CONCLUSIONS
  In select patients, extubation in the OR after on-pump valve surgery is safe. It is facilitated by shorter duration of CPB and pulmonary perfusion and ventilation during CPB. doi: 10.1111/jocs.12736 (J Card Surg 2016;31:274-281).
authors.affiliation: Department of Anesthesiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Yiliam F
authors.initials: YF
authors.lastname: Rodriguez-Blanco
authors.affiliation: Department of Anesthesiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Enisa M F
authors.initials: EM
authors.lastname: Carvalho
authors.affiliation: Private Practice, Miami, Florida.
authors.forename: Angela
authors.initials: A
authors.lastname: Gologorsky
authors.affiliation: Department of Biostatistics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Kaming
authors.initials: K
authors.lastname: Lo
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Tomas A
authors.initials: TA
authors.lastname: Salerno
authors.affiliation: Department of Anesthesiology, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Edward
authors.initials: E
authors.lastname: Gologorsky
mesh_terms: D060666:Airway Extubation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009873:Operating Rooms; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors