Unplanned Reintubation Following Cardiac Surgery: Incidence, Timing, Risk Factors, and Outcomes.
OBJECTIVE
To determine the incidence, timing, risk factors for, and outcomes after unplanned reintubation following cardiac surgery in adults.


METHODS
Retrospective analysis of admission data from the American College of Surgeons National Surgical Quality Improvement Project Database, 2007-2013, inclusive. Univariate and multivariate analyses of risk factors and outcomes.


METHODS
A total of 18,571 patients, over 18 years of age, undergoing cardiac surgery.


METHODS
Not applicable.


RESULTS
Reintubation incidence was 4.0%. Risk factors included older age, preoperative partial or total dependence, dyspnea at rest or on exertion, chronic kidney disease, chronic obstructive pulmonary disease, previous cardiac surgery, congestive heart failure, emergency surgery, longer duration of surgery, and mitral and tricuspid valve surgery. Patients requiring reintubation after surgery had 7.5 times higher mortality (21.9% v 2.9%), longer hospital admissions (22.2 v 7.8 days), and were less likely to be discharged home within 30 days (35% v 80%). Multivariate analysis demonstrated increased risk of failure to wean from the ventilator, pneumonia, sepsis, pulmonary embolism, deep vein thrombosis, and discharge to skilled care, rehabilitation, or other care.


CONCLUSIONS
Patients reintubated after cardiac surgery had significantly higher mortality, complication rates, and length of stay. Novel risk factors identified could be used to tailor extubation timing and strategy appropriately. Compared to noncardiac surgery, some risk factors for reintubation differed and risk continued beyond the immediate postoperative period to a greater degree.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
Anair
A
Beverly
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
Ethan Y
EY
Brovman
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
Raymond J
RJ
Malapero
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
Robert W
RW
Lekowski
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: rurman@partners.org.
Richard D
RD
Urman
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000628:therapy*; D012042:Registries; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
NSQIP; cardiac surgery; outcomes; postoperative; reintubation; risk factors