Risk factors for reintubation in the post-anaesthetic care unit: a case–control study

Abstract

Editor's key points † This study investigates the risk factors for reintubation in post-anaesthetic care units related to anaesthetic processes. † Risk factors were age ,1 yr, chronic pulmonary disease, preoperative hypoalbuminaemia and renal insufficiency, head and neck surgery, airway surgery, cardiothoracic surgery, cardiac catheterization, emergency case, duration of operation more than 3 h, ASA physical status III, and the use of certain neuromuscular blocking agents. Background. Risk factors for reintubation in post-anaesthetic care units related to anaesthetic processes have not previously been reported. Our goal was to identify risk factors for reintubation in general surgical patients. Methods. A time-matched, case-control study was conducted on anaesthetic patients between 2001 and 2011. One hundred and sixty-four reintubated patients were compared with 656 randomly selected controls. Results. Independent risk factors for reintubation were age ,1 yr vs age 30-49 yr [odds ratio (OR)¼16.4, 95% confidence interval (CI)¼5.7-47.7], chronic pulmonary disease (OR¼2.1, CI¼1.1-4.0), preoperative hypoalbuminaemia (OR¼4.9, CI¼2.4 -10), creatinine clearance ,24 vs .60 (OR¼4.1, CI¼1.2-13.4), emergency case (OR¼1.8, CI¼1.0-3.1), operative time .3 vs ,1 h (OR¼3.0, CI¼1.5 -6.2), airway surgery (OR¼32.2, CI¼13.6 -76), head and neck surgery (OR¼3.4, CI¼1.8 -6.2), cardiac surgery (OR¼3.8, CI¼1.1 -13.4), thoracic surgery (OR¼6.3, CI¼1.9-21.2), cardiac catheterization (OR¼2.5, CI¼1.1 -5.5), ASA physical status III (OR¼3.8, CI¼1.4-10), and the use of certain types of neuromuscular blocking agent (P,0.001). Conclusions. Age ,1 yr, chronic pulmonary disease, preoperative hypoalbuminaemia, and renal insufficiency were patient factors for reintubation. Emergency case, head and neck, cardiothoracic and airway surgery, and operative time .3 h were operative factors, while certain neuromuscular blocking agents and ASA physical status III were anaesthetic factors for reintubation. ParticipantsThe anaesthetic database included all patients who were serviced by anaesthetists either inside or outside the operating theatres. The database consisted of two parts. The first part contained preoperative data and intraoperative data which were entered into the database upon admission to the PACU by the anaesthetists involved in the patient's intraoperative care. The second part consisted of postoperative

Validated Model for Predicting Postoperative Respiratory Failure

“…Recent work has shown that procedures lasting more than 3 hours and patients with higher American Society of Anesthesiologists scores are at greater risk for early postoperative intubation. 19 These findings have been confirmed in the general surgical patient population, and anesthesia time frequently emerges as an independent predictor of postoperative respiratory morbidity. 20 Both American Society of Anesthesiologists score and operative time are key risk factors identified in this study that are associated with postoperative respiratory failure.…”

Analysis of Risk Factors, Morbidity, and Cost Associated with Respiratory Complications following Abdominal Wall Reconstruction

“…26,27 In this study, American Society of Anesthesiologists physical status served as a significant predictor of postoperative respiratory morbidity (OR, 27.2; p = 0.019). This finding is critical because this appeared to be the only reliable preoperative clinical variable predictive of respiratory morbidity.…”

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children

“…UAO in combination with reintubation occurred mostly during 60-180 minutes of anesthesia when the operation was finished and the airway device was taken out. The main risk factors were age < 1 years and airway surgery, a result supported by Ing et al [22] and Rujirojindakul et al [23] Anesthesia-related risk factors could not be determined because of the low number (23) of events.…”