Effect of differences in extubation timing on postoperative care following abdominal aortic replacement surgery: a comparison study

Abstract

BackgroundAbdominal aortic replacement requires an extensive incision and strict blood pressure control, making rapid extubation of the tracheal tube and pain management difficult. The effects of extubation timing on the postoperative course and medical costs in the intensive care unit (ICU) were analyzed.MethodsPatients who underwent elective abdominal aortic replacement were evaluated retrospectively. Patients were divided into those extubated on the day of surgery (Group A) and those extubated later (Group B). Group A was subdivided into extubation in the operating room (Group A1) or in the ICU (Group A2). Intubation time in the ICU, postoperative ICU stay, hospital stay, and total ICU expenses were compared among the four groups.ResultsOf the 191 patients, 95 were extubated on the day of surgery (Group A) and 96 later (Group B). The two groups differed in age and percutaneous coronary intervention history. Surgery and anesthesia durations, intraoperative infusion volume, and intraoperative bleeding amounts differed significantly in the two groups. Epidural anesthesia was given more frequently in Group A. Mean intubation time in the ICU (2.6 ± 2.8 vs 17.4 ± 5.1 hours, P < 0.01), the ICU stay (2.1 ± 0.3 vs 2.4 ± 0.8 days, P < 0.01), and the hospital stay (16.4 ± 5.2 vs 20.2 ± 12.5 days, P = 0.02) were significantly shorter, and total ICU expenses were significantly lower (1,036 ± 307 vs 1,565 ± 1,072 dollars, P < 0.01), in Group A than in Group B. Of the 95 patients in Group A, 34 were extubated in the operating room (Group A1) and 61 in the ICU (Group A2). Arrhythmia, epidural anesthesia, and the amount of intraoperative infusion amount were significantly higher, and the percentage of women significantly lower, in Group A1 (vs Group A2). Postoperative ICU and hospital stays and the ICU costs were not significantly different.ConclusionTracheal tube extubation on the day of abdominal aortic replacement surgery resulted in better postoperative course and lower costs than when extubation occurred later. Patients extubated in the operating room or the ICU on the day of surgery had similar postoperative courses and costs.

Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study

“…While it was not surprising that patients with delayed extubation had a worse outcome, we discovered that early extubation within 35 minutes in the operating room, rather than in the ICU, had an independent effect. Consistent with our results, previous studies have shown that early extubation is associated with reduced PPCs and shorter hospital stay after major surgery, but few have focused on the neurosurgical subgroup [6][7][8][9][10][11]. However, early recovery of patients' breathing and consciousness is conducive to neurosurgeons' neurological evaluation, especially in the "rapid awaking strategy" [3].…”

“…We determined the sample size from a similar study of previous non-cardiac surgery [6,[11][12][13]. And we retrospectively analyzed 820 patients who underwent meningioma resection at the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020.…”

“…POP, one of the most common postoperative pulmonary complications (PPCs) after surgery, not only prolongs the hospital stay, but even increases the risk of other severe complications and postoperative mortality [4,5]. Previous studies have shown that early extubation is associated with reduced PPCs and hospital stay after major surgery, but they mostly compared the prognosis of patients with extubation in the intensive care unit (ICU) and those patients with extubation in operating room [6][7][8][9][10][11]. To date, there are no studies regarding the optimal timing of extubation of ventilated patients after craniotomy in the operating room.…”

Early extubation reduces respiratory complications and hospital length of stay following repair of abdominal aortic aneurysms

“…However, this research was limited by limited sample size and a lack of adjusted analysis. 8 Moreover, no previous studies have evaluated the impact of extubation time on outcomes following endovascular repair (EVAR). Given these gaps in knowledge, this study aims to evaluate the effect of extubation time on patients’ outcomes following EVAR and open repair.…”