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 after general anesthesia during five years. Cases due to AAC were matched 1:4 with randomly selected controls.Results: Univariate analysis revealed that male sex, age >65, ASA physical status 3, 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 significantly associated with AAC-caused unplanned reintubation. Multivariate 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), and a high fluid load (OR=3.04, 95% CI=1.16-7.99, P=0.024) were independent risk factors for 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, and high fluid load were risk factors for AAC-caused unplanned reintubation, which was associated with increased postoperative hospital and ICU days.