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

Chen, Si; Zhang, Yuelun; Che, Lu; Shen, Le; Huang, Yuguang

doi:10.1186/s12871-021-01238-4

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…Predictors for postoperative reintubation varied widely among different literature reports. However, the risk of reintubation has been reported to increase gradually with age in most studies ( 7 , 9 , 11 , 15 ), which was consistent with the results of this study. Brovman et al conducted a biinstitutional study to explore the relationship between early extubation and postoperative reintubation after elective cardiac surgery, finding that older age was an independent risk factor for postoperative reintubation ( 11 ).…”

Section: Discussionsupporting

confidence: 92%

“…Reintubation is one of the commonly performed surgical procedures for patients with cardiopulmonary insufficiency and consciousness dysfunction after cardiovascular surgery, which is closely related to various adverse outcomes, prolonged hospital stay and increased medical costs ( 1 – 8 ). The reintubation rates reported in previous literature varied considerably due to differences in surgical populations across studies ( 9 – 13 ). Compared with other types of surgery, the incidence of reintubation after Stanford type A aortic dissection surgery (AADS) is relatively higher in the literature, ranging from 7.8 to 20.6% ( 13 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Prediction and prognosis of reintubation after surgery for Stanford type A aortic dissection

Yao

Wang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundReintubation is a serious adverse respiratory event after Stanford type A aortic dissection surgery (AADS), however, published studies focused on reintubation after AADS are very limited worldwide. The objectives of the current study were to establish an early risk prediction model for reintubation after AADS and to clarify its relationship with short-term and long-term prognosis.MethodsPatients undergoing AADS between 2016–2019 in a single institution were identified and divided into two groups based on whether reintubation was performed. Independent predictors were identified by univariable and multivariable analysis and a clinical prediction model was then established. Internal validation was performed using bootstrap method with 1,000 replications. The relationship between reintubation and clinical outcomes was determined by univariable and propensity score matching analysis.ResultsReintubation were performed in 72 of the 492 included patients (14.6%). Three preoperative and one intraoperative predictors for reintubation were identified by multivariable analysis, including older age, smoking history, renal insufficiency and transfusion of intraoperative red blood cells. The model established using the above four predictors showed moderate discrimination (AUC = 0.753, 95% CI, [0.695–0.811]), good calibration (Hosmer-Lemeshow χ2 value = 3.282, P = 0.915) and clinical utility. Risk stratification was performed and three risk intervals were identified. Reintubation was closely associated with poorer in-hospital outcomes, however, no statistically significant association between reintubation and long-term outcomes has been observed in patients who were discharged successfully after surgery.ConclusionsThe requirement of reintubation after AADS is prevalent, closely related to adverse in-hospital outcomes, but there is no statistically significant association between reintubation and long-term outcomes. Predictors were identified and a risk model predicting reintubation was established, which may have clinical utility in early individualized risk assessment and targeted intervention.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Prediction and prognosis of reintubation after surgery for Stanford type A aortic dissection

Yao

Wang

et al. 2022

Front. Cardiovasc. Med.

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“…The ability to collect these data is crucial for future studies. These study limitations are similar to those described by Blum et al, in their case-control study of 93 surgical patients who developed postoperative ARDS [ 11 ] and Chen et al, in their case-control study of 36 patients who required unplanned reintubation following general anesthesia [ 70 ]. Despite the limitations associated with studying rare events, early and novel studies on a topic, such as our study of L-PRF, are often hypothesis generating and serve as a good launching point to design higher powered future studies.…”

Section: Discussionsupporting

confidence: 73%

Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC)

et al. 2022

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Background Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF. Methods This was a retrospective matched case-control study of 59,073 consecutive adult patients admitted for elective non-cardiac and non-pulmonary surgical procedures at one of five University of California academic medical centers between October 2012 and September 2015. We identified patients with L-PRF, confirmed by surgeon and intensivist subject matter expert review, and matched them 1:1 to patients who did not develop PRF (No-PRF) based on hospital, age, and surgical procedure. We then analyzed risk factors and outcomes associated with L-PRF compared to E-PRF and No-PRF. Results Among 95 patients with L-PRF, 50.5% were female, 71.6% white, 27.4% Hispanic, and 53.7% Medicare recipients; the median age was 63 years (IQR 56, 70). Compared to 95 matched patients with No-PRF and 319 patients who developed E-PRF, L-PRF was associated with higher morbidity and mortality, longer hospital and intensive care unit length of stay, and increased costs. Compared to No-PRF, factors associated with L-PRF included: preexisiting neurologic disease (OR 4.36, 95% CI 1.81–10.46), anesthesia duration per hour (OR 1.22, 95% CI 1.04–1.44), and maximum intraoperative peak inspiratory pressure per cm H20 (OR 1.14, 95% CI 1.06–1.22). Conclusions We identified that pre-existing neurologic disease, longer duration of anesthesia, and greater maximum intraoperative peak inspiratory pressures were associated with respiratory failure that developed six or more days after elective surgery in adult patients (L-PRF). Interventions targeting these factors may be worthy of future evaluation.

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“…Head and neck surgery has previously been identified as a risk factor for unplanned postoperative reintubation, with notable racial differences in outcomes in the pediatric literature [6,12,13]. One study showed that Black children had higher odds of perioperative pulmonary complications after otolaryngology surgery, including twofold higher odds for unplanned reintubation [14].…”

Section: Discussionmentioning

confidence: 99%

“…Unplanned reintubation is a significant postoperative adverse event, as it is associated with increased postoperative pneumonia, tracheostomy, length of hospital stay, mortality, and greater financial burden on the hospital and patients [4,5]. In a case-control study by Chen et al involving 123,068 surgical patients, risk factors associated with reintubation included age greater than 65 years, increased American Society of Anesthesiologists (ASA) physical status classification, high fluid volume status, and head and neck or thoracic surgery [6].…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in 30-Day Reintubation After Head and Neck Surgery

Burton¹,

Wall²,

Le³

et al. 2023

Cureus

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BackgroundThis study aimed to examine the association of race and ethnicity with 30-day unplanned reintubation following head and neck surgery. MethodologyA retrospective analysis of head and neck surgery patients aged greater than or equal to 18 years was extracted from the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020. Patient demographics, comorbidities, and 30-day reintubation were included in the analysis. Pearson's chi-square and independent samples t-test were used to compare reintubation cohorts. Multivariable logistic regression was used to identify the association of race and ethnicity with 30-day reintubation. ResultsOf the total 108,442 head and neck surgery cases included, 74.9% of patients were non-Hispanic White, 17.3% were non-Hispanic Black, and 7.7% were Hispanic. The overall 30-day reintubation rate was 0.33%. After adjusting for age, body mass index, sex, and comorbidities, non-Hispanic Black patients had increased 30-day reintubation compared to non-Hispanic White patients (odds ratio [OR] = 2.14, 95% confidence interval [CI] 1.70-2.69, and P < 0.0001). There was no difference in 30-day reintubation for Hispanic patients compared to non-Hispanic White patients (OR = 1.08, 95% CI 0.67-1.65, and P = 0.747). ConclusionsThis analysis showed that non-Hispanic Black patients disproportionately had higher odds of 30-day reintubation following head and neck surgery. Hispanic ethnicity was not associated with increased odds of 30-day reintubation. More studies are needed to investigate the reasons for these racial differences.

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

Cited by 8 publications

References 28 publications

Prediction and prognosis of reintubation after surgery for Stanford type A aortic dissection

Prediction and prognosis of reintubation after surgery for Stanford type A aortic dissection

Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC)

Racial Differences in 30-Day Reintubation After Head and Neck Surgery

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