Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

Abstract

Background: This study aimed to identify the risk factors and evaluate the prognosis of unplanned reintubation caused by acute airway compromise (AAC) after general anesthesia.Methods: This case-control study included surgical patients who underwent unplanned reintubation in the operating room and postanesthesia care unit after general anesthesia between January 1, 2014, and December 31, 2018. Cases due to AAC were matched 1:4 with randomly selected controls.Results: A total of 123,068 patients were included, and reintubation due to AAC was performed in 36 patients (approximate incidence 0.03%). Univariable analysis revealed that male sex, age >65, ASA physical status 3, sepsis, heart disease history, cerebral infarction history, Cormack Lehane grade, surgery type, fresh frozen plasma infusion, increased intubation duration, white blood cell count, and creatinine clearance rate were related to AAC-caused unplanned reintubation. Multivariable analysis revealed that age >65 (OR=7.50, 95% CI 2.47-22.81, P<0.001), ASA physical status 3 (OR=6.51, 95% CI 1.18-35.92, P=0.032), head-neck surgery (OR=4.94, 95% CI 1.33-18.36, P=0.017) or thoracic surgery (OR=12.56, 95% CI 2.93-53.90, P<0.001), a high fluid load (OR=3.04, 95% CI 1.16-7.99, P=0.024) and sepsis (OR=24.08, 95% CI 2.51-231.51, P=0.006) were associated with AAC-caused unplanned reintubation. AAC-caused unplanned reintubation patients had longer postoperative hospital (OR=5.26, 95% CI 1.57-8.95, P<0.001) and intensive care unit days (OR=3.94, 95% CI 1.69-6.18, P<0.001).Conclusions: Age>65, ASA physical status 3, head-neck or thoracic surgery, high fluid load and sepsis were found to be associated with AAC-caused unplanned reintubation.

Racial Disparities in Postoperative Outcomes Following Operative Management of Pediatric Developmental Dysplasia of the Hip

“…On the basis of a study looking at adult risk factors for unplanned reintubation, an ASA status of III was determined to be one of the risk factors leading to acute airway compromise and unplanned reintubation. 28 Our URM cohort was found to be more likely to have a higher ASA score when compared with the White cohort, but the significant difference in reintubation rates was present even after controlling for ASA score. Although multivariable analysis was done to correct for the impact of increased pulmonary comorbidities seen among the URM cohort on reintubation rate, the relationship between pulmonary comorbidities and reintubation rate may not be purely linear and could still have some influence on the significant reintubation rate despite correction.…”

“…Among these studies, there have not been any investigations into time to extubation or rates of unplanned reintubation following operative management of pediatric patients. On the basis of a study looking at adult risk factors for unplanned reintubation, an ASA status of III was determined to be one of the risk factors leading to acute airway compromise and unplanned reintubation 28. Our URM cohort was found to be more likely to have a higher ASA score when compared with the White cohort, but the significant difference in reintubation rates was present even after controlling for ASA score.…”