Extubation in the operating room results in fewer composite mechanical ventilation-related adverse outcomes in patients after liver transplantation: a retrospective cohort study

Abstract

Background To investigate the effect of extubation in the operating room (OR) on mechanical ventilation-related adverse outcomes in patients who undergo liver transplantation. Methods Patients who underwent liver transplantation between January 2016 and December 2019 were included. According to the timing of extubation, patients were divided into OR extubation group and intensive care unit (ICU) extubation group. The propensity score was used to match OR extubation group and ICU extubation group at a 1:2 ratio by demographical and clinical covariates. The primary outcome was a composite of mechanical ventilation-related adverse outcomes, including 30-day all-cause mortality, in-hospital acute kidney injury (stage 2 or 3), and in-hospital moderate to severe pulmonary complications. Secondary outcomes included in-hospital moderate to severe infectious complications, unplanned reintubation rates, ICU and postoperative hospital lengths of stay, and total hospital cost. Results A total of 438 patients were enrolled. After propensity score matching, 94 patients were in OR extubation group and 148 patients were in ICU extubation group. Incidence of the composite mechanical ventilation-related adverse outcomes was significantly lower in OR extubation group than ICU extubation group, even after adjusting for confounding factors (19.1% vs. 31.8%; Odds Ratio, 0.509; 95% Confidence Index [CI], 0.274-0.946; P=0.031). The duration of ICU stay was much shorter in OR extubation group than ICU extubation group (median 4, Interquartile range [IQR] (3 ~ 6) vs. median 6, IQR (4 ~ 8); P<0.001). Meanwhile, extubation in the OR led to a significant reduction of total hospital cost compared with extubation in the ICU (median 3.9, IQR (3.5 ~ 4.6) 10000 US dollars vs. median 4.1, IQR (3.8 ~ 5.1) 10000 US dollars; P=0.021). However, there were no statistically significant differences in moderate to severe infectious complications, unplanned reintubation rates, and the length of postoperative hospital stay between groups. Conclusions Among patients who underwent liver transplantation, extubation in the OR compared with extubation in the ICU, significantly reduced the primary composite outcome of 30-day all-cause mortality, in-hospital acute kidney injury (stage 2 or 3), or in-hospital moderate to severe pulmonary complications. Trial registration The trial was registered at www.clinicaltrials.gov with registration number NCT04261816. Retrospectively registered on 1st February 2020.

Factors associated with artificial airway retention after skull base chordoma resection: A retrospective cohort study

“…Among them, 30.97% of patients required postoperative AA retention, which was found to be associated with an increased frequency of pulmonary complications and a poor prognosis. The results of this study are consistent with those of studies of nonneurosurgical patients (9)(10)(11)(12). Prolonged AA retention can lead to complications, including lung infection, glottis narrowing, and difficulty swallowing (13).…”

“…Retained AAs and mechanical ventilation can provide direct access to the lungs for pathogens and reduce the immune barrier function of the mucosa, which may increase the risk of postoperative pulmonary complications (10). We identified several risk factors for perioperative AA retention, and the possibility of AA retention is considerable for patients with specific characteristics.…”

Preventing Postoperative Infection In Liver Transplant Patients : Preoperative Assessment, Intraoperative Challenges And Postoperative Management

“…Notably, the emergence of multidrug-resistant (MDR) organisms further increases medical care cost and prolongs the length of hospital stay 8 ,which emerged as a leading contributor to patient mortality. 8,9 Worse, clinical infection symptoms in the LT patients are usually blurred or even absent, leading to a delay of diagnosis causing severe consequences. 5 Thus, reducing the infection risk and initiating proper empiric antibiotics rise to big challenge to the surgeon and infection clinician, and at times become highly controversial.…”