Preoperative and Intraoperative Predictive Factors of Immediate Extubation After Neonatal Cardiac Surgery.
BACKGROUND
We sought to identify preoperative and intraoperative predictors of immediate extubation (IE) after open heart surgery in neonates. The effect of IE on the postoperative intensive care unit (ICU) length of stay (LOS), cost of postoperative ICU care, operating room turnover, and reintubation rates was assessed.


METHODS
Patients younger than 31 days who underwent cardiac surgery with cardiopulmonary bypass (January 2010 to December 2013) at a tertiary-care children's hospital were studied. Immediate extubation was defined as successful extubation before termination of anesthetic care. Data on preoperative and intraoperative variables were compared using descriptive, bivariate, and multivariate statistics to identify the predictors of IE. Propensity scores were used to assess effects of IE on ICU LOS, the cost of ICU care, reintubation rates, and operating room turnover time.


RESULTS
One hundred forty-eight procedures done at a median age of 7 days resulted in 45 IEs (30.4%). The IE rate was 22.2% with single-ventricle heart disease. Independent predictors of IE were the absence of the need for preoperative ventilatory assistance, higher gestational age, anesthesiologist, and shorter cardiopulmonary bypass. Immediate extubation was associated with shorter ICU LOS (8.3 versus 12.7 days; p < 0.0001) and lower cost of ICU care (mean postoperative ICU charges, $157,449 versus $198,197; p < 0.0001) with no significant difference in the probability of reintubation (p = 0.7). Immediate extubation was associated with longer operating room turnover time (38.4 versus 46.7 minutes; p = 0.009).


CONCLUSIONS
Immediate extubation was accomplished in 30.4% of neonates undergoing open heart surgery involving cardiopulmonary bypass. Immediate extubation was associated with lesser ICU LOS, postoperative ICU costs, and minimal increase in operating room turnover time, but without an increase in reintubation rates. Low gestational age, preoperative ventilatory support requirement, and prolonged cardiopulmonary bypass time were inversely associated with the ability to accomplish IE.
Department of Anesthesiology, University of Nebraska College of Medicine and Children's Hospital & Medical Center, Omaha, Nebraska.
Joby
J
Varghese
Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital & Medical Center, Omaha, Nebraska. Electronic address: skutty@unmc.edu.
Shelby
S
Kutty
Division of Cardiovascular Surgery, University of Nebraska College of Medicine and Children's Hospital & Medical Center, Omaha, Nebraska.
Ibrahim
I
Abdullah
Department of Biostatistics, University of Nebraska College of Medicine and Children's Hospital & Medical Center, Omaha, Nebraska.
Sandra
S
Hall
Department of Biostatistics, University of Nebraska College of Medicine and Children's Hospital & Medical Center, Omaha, Nebraska.
Valerie
V
Shostrom
Division of Cardiovascular Surgery, University of Nebraska College of Medicine and Children's Hospital & Medical Center, Omaha, Nebraska.
James M
JM
Hammel
D060666:Airway Extubation / Q000191:economics / Q000706:statistics & numerical data; D000758:Anesthesia / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000191:economics; D002315:Cardiopulmonary Bypass; D005260:Female; D005865:Gestational Age; D017721:Hospital Costs; D006801:Humans; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D009873:Operating Rooms / Q000191:economics; D061646:Operative Time; D011182:Postoperative Care / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012372:ROC Curve; D011997:Recovery Room / Q000191:economics / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies