title: Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis.
abstract: Unplanned postoperative reintubation increases the risk of mortality, but associated factors are unclear.
  
  
  
  To elucidate factors associated with increased mortality risk in patients with unplanned postoperative reintubation.
  
  
  
  Retrospective study. Patients older than 40 years who underwent unplanned reintubation from 2005 to 2010 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Multiple regression models were used to examine the impact on mortality of factors that included the modified frailty index (mFI) we developed, American Society of Anesthesiologists (ASA) score, age decile, and days to reintubation.
  
  
  
  Mortality.
  
  
  
  A total of 17,051 postoperative reintubations in adults were analyzed. Overall mortality was 29.4% (n = 5009). On postoperative day 1, 4434 patients were reintubated and 878 (19.8%) died. On postoperative day 7 and beyond, 6329 patients were reintubated and 2215 (35.0%) died. Increasing mFI resulted in increasing incidence of mortality (mFl of 0 = 20.5% mortality vs mFl of 0.37-0.45 = 41.7% mortality). As ASA score increased from 1 to 5, reintubation was associated with a mortality of 12.1% to 41.6%, respectively. Similarly, increasing age decile was associated with increasing incidence of mortality (40-49 years, 17.9% vs 80-89 years, 42.1%). After adjustment for confounding factors, mFI, ASA score, age decile, and increasing number of days to reintubation were independently and significantly associated with increased mortality in the study population.
  
  
  
  Among patients who underwent unplanned reintubation, older and more frail patients had an increased risk of mortality.
authors: Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, MI. ekarama1@hfhs.org.
authors: Efstathios
authors: E
authors: Karamanos
authors: Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, MI. nschmoek1@hfhs.org.
authors: Nathan
authors: N
authors: Schmoekel
authors: Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, MI. dblyden2@hfhs.org.
authors: Dionne
authors: D
authors: Blyden
authors: Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, MI. afalvo1@hfhs.org.
authors: Anthony
authors: A
authors: Falvo
authors: Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, MI. irubinf1@hfhs.org.
authors: Ilan
authors: I
authors: Rubinfeld
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D013502:General Surgery / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors