Unplanned postoperative reintubation following general and vascular surgical procedures: Outcomes and risk factors

Abstract

BackgroundUnplanned postoperative reintubation (UPR) is a marker for severe adverse outcomes following general and vascular surgery.Study designA retrospective analysis of 8809 adult patients, aged 18 years and older, who underwent major general and vascular surgery at a large single-center urban hospital was conducted from January 2013 to September 2016. Patients were grouped into those who experienced UPR and those who did not. Univariate and multivariate regression analyses were used to identify predictors of UPR, and association of UPR with adverse postoperative outcomes. All regression models had Hosmer-Lemeshow P > 0.05, and C-statistic >0.75, indicating excellent goodness-of-fit and discrimination.ResultsOf the 8809 patients included, 138 (1.6%) experienced UPR. There was no statistical difference in incidence of UPR between general and vascular surgery patients (p = 0.53). Independent predictors of UPR advanced age (OR 5.1, 95%CI 3.5–7.5, p < 0.01), higher ASA status (OR 7.9, 95%CI 5.6–11.1, p < 0.01), CHF (OR 7.0, 95%CI 3.6–13.9, p = 0.02), acute renal failure or dialysis (OR 3.1, 95%CI 1.8–5.7, p = 0.01), weight loss (OR 5.2, 95%CI 2.8–9.6, p = 0.01), systemic sepsis (OR 4.8, 95%CI 3.4–6.9, p < 0.01), elevated preoperative creatinine (OR 4.2, 95%CI 3.0–5.9, p = 0.01), hypoalbuminemia (OR 5.3, 95% CI 3.8–7.5, p = 0.01), and anemia (OR 4.0, 95%CI 2.8–5.9, p < 0.01). Following surgery, UPR was associated with increased mortality (OR 3.8, 95%CI 2.7–5.2, p < 0.01), pulmonary complications (OR 1.8, 95%CI 1.7–2.0, p < 0.01), renal complications (OR 2.6, 95%CI 1.7–3.5, p < 0.01), cardiac complications (OR 4.6, 95%CI 2.0–6.7, p < 0.01), postoperative RBC transfusion (OR 5.7, 95%CI 3.8–8.6,p < 0.01), and prolonged hospitalization (OR 1.8, 95%CI 1.5–2.4, p < 0.01).ConclusionUPR is significantly associated with postoperative morbidity and mortality. Perioperative management aimed at decreasing incidences of UPR after noncardiac surgery should target preoperative anemia in addition to previously identified predictors.

Risk Factors for Unplanned Reintubation Caused by Acute Airway Compromise After General Anesthesia: A Case-control Study

“…Based on our results, age >65 yrs and ASA physical status 3 were identi ed as risk factors for unplanned reintubation caused by AAC. This result was in accordance with previous results that noted that advanced age and ASA physical status ≥3 should be considered independent risk factors for postoperative respiratory failure [7,8] . Age ≥65 was also shown to be an important risk factor for failed extubation in ICU patients [9] .…”

“…Thus, FFP transfusion may be correlated with ARDS and reintubation after operation. RBC transfusion was not identi ed as an independent risk factor, consistent with the result from Acheampong D and colleagues [8] . A uid load ≥ 20 ml kg -1 was revealed as a risk factor in this study; however, other studies found that uid balance or overload was not a risk factor signi cant, possibly due to the different de nitions of uid load [12,20] .…”

“…Thus, we concluded WBC counts may be of little clinical signi cance. Hypoalbuminemia was also suggested to be highly associated with postoperative reintubation in some previous studies [8,14] . However, such a result was not observed in this study.…”

“…Numerous studies have concluded that chronic kidney disease [11] and renal insu ciency [2,8,14] are signi cant risk factors for reintubation. Although increased WBC counts were identi ed to be signi cant in the univariate analysis, the WBC counts in both groups remained within the normal range.…”

Extubation failure in operating room: Review of management in 50 patients at a single center

“…Patients are usually extubated postoperatively once ventilatory support or airway protection needs subside. However, some patients cannot be weaned from mechanical ventilation during this period [1]. The risk factors for failure of extubation include old age, male gender, smoking, high American Society of Anesthesiologists (ASA) score, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and obesity [2].…”