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Ann Thorac Surg 2004;77:781-788
© 2004 The Society of Thoracic Surgeons
a Department of Surgery, (Division of Cardiology), and Outcomes Research and Assessment Group, Duke University Medical Center, Durham, North Carolina, USA
b Department of Biostatistics, (Division of Cardiology), and Outcomes Research and Assessment Group, Duke University Medical Center, Durham, North Carolina, USA
c Department of Bioinformatics, (Division of Cardiology), and Outcomes Research and Assessment Group, Duke University Medical Center, Durham, North Carolina, USA
d Department of Medicine, (Division of Cardiology), and Outcomes Research and Assessment Group, Duke University Medical Center, Durham, North Carolina, USA
e Department of Surgery, Division of General Surgery, University Hospital Basel, Basel, Switzerland
f Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama, USA
g Birmingham VA Medical Center, Birmingham, Alabama, USA
h Alabama Quality Assurance Foundation, Birmingham, Alabama, USA
i Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), University of Alabama, Birmingham, Alabama, USA
j Center For Aging, University of Alabama at Birmingham, Birmingham, Alabama, USA
Accepted for publication September 5, 2003.
* Address reprint requests to Dr Peterson, Duke Clinical Research Institute, Duke University Medical Center, Box 17969, Durham, NC, USA 27715
e-mail: peter016{at}mc.duke.edu
BACKGROUND: While early extubation after coronary artery bypass grafting (CABG) has been associated with resource savings, its effect on patient outcomes remains unclear. The goal of the present investigation was to evaluate whether early extubation can be performed safely in elderly CABG patients in community practice.
METHODS: We studied 6,446 CABG patients, aged 65 years and older, treated at 35 hospitals between 1995 and 1998. Patients were categorized based on their post-CABG extubation duration (early, < 6 hours; intermediate, 6 to < 12 hours; and late, 12 to 24 hours). We compared unadjusted and risk-adjusted mortality, reintubation rates, and post-CABG length of stay (pLOS). We also examined the association between patients' intubation time and outcomes among patients with similar propensity for early extubation and among high-risk patient subgroups.
RESULTS: The overall mean post-CABG intubation time was 9.8 (SD 5.7) hours with 29% of patients extubated within 6 hours. After adjusting for preoperative risk factors patients extubated in less than 6 hours had significantly shorter postoperative hospital stays than those with later extubation times. Patients extubated early also tended to have equal or better risk-adjusted mortality than those with intermediate (odds ratio: 1.69, p = 0.08) or long intubation times (odds ratio: 1.97, p = 0.02). These results were consistent among patients with similar preoperative propensity for early extubation and among important high-risk patient subgroups. There was no evidence for higher reintubation rates among elderly patients selected for early extubation.
CONCLUSIONS: In community practice, early extubation after CABG can be achieved safely in selected elderly patients. This practice was associated with shorter hospital stays without adverse impact on postoperative outcomes.
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