Unplanned Reintubation Following Cardiac Surgery: Incidence, Timing, Risk Factors, and Outcomes.

ABSTRACT

OBJECTIVES: To determine the incidence, timing, risk factors for, and outcomes after unplanned reintubation following cardiac surgery in adults. DESIGN: Retrospective analysis of admission data from the American College of Surgeons National Surgical Quality Improvement Project Database, 2007-2013, inclusive. Univariate and multivariate analyses of risk factors and outcomes. PARTICIPANTS: A total of 18,571 patients, over 18 years of age, undergoing cardiac surgery. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Reintubation incidence was 4.0%. Risk factors included older age, preoperative partial or total dependence, dyspnea at rest or on exertion, chronic kidney disease, chronic obstructive pulmonary disease, previous cardiac surgery, congestive heart failure, emergency surgery, longer duration of surgery, and mitral and tricuspid valve surgery. Patients requiring reintubation after surgery had 7.5 times higher mortality (21.9% v 2.9%), longer hospital admissions (22.2 v 7.8 days), and were less likely to be discharged home within 30 days (35% v 80%). Multivariate analysis demonstrated increased risk of failure to wean from the ventilator, pneumonia, sepsis, pulmonary embolism, deep vein thrombosis, and discharge to skilled care, rehabilitation, or other care. CONCLUSIONS: Patients reintubated after cardiac surgery had significantly higher mortality, complication rates, and length of stay. Novel risk factors identified could be used to tailor extubation timing and strategy appropriately. Compared to noncardiac surgery, some risk factors for reintubation differed and risk continued beyond the immediate postoperative period to a greater degree.