title: Early Extubation After Repair of Tetralogy of Fallot and the Fontan Procedure: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database.
abstract: BACKGROUND
  There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood.
  
  
  METHODS
  Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded.
  
  
  RESULTS
  Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early extubation after TOF repair was associated with heavier weight at operation (p < 0.001) and fewer preoperative risk factors (p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate (p = 0.04). No association was found between center early extubation rate and PLOS for Fontan procedures (p = 0.08).
  
  
  CONCLUSIONS
  Early extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
authors.affiliation: Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia. Electronic address: wmahle@emory.edu.
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
authors.affiliation: All Children's Hospital and Johns Hopkins University, St. Petersburg, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Johns Hopkins Heart and Vascular Institute, Baltimore, Maryland.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
authors.affiliation: University of Michigan, Ann Arbor, MI.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: Kosair Children's Hospital, Louisville, Kentucky.
authors.forename: Erle H
authors.initials: EH
authors.lastname: Austin
authors.affiliation: Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
mesh_terms: D060666:Airway Extubation; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D018729:Fontan Procedure; D006801:Humans; D007223:Infant; D008297:Male; D066231:Surgeons; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors