Predictors of immediate tracheal extubation in the operating room after liver transplantation

Immediate postoperative extubation may reduce the incidence of postoperative respiratory complications after orthotopic liver transplantation (OLT). We evaluated the predictors of immediate tracheal extubation in the operating room (OR) in our patients by retrospectively reviewing data from all patients who underwent OLT between January 2004 and June 2006. The patients were divided into two groups according to whether they had undergone extubation in the OR (group 1 n=52) or in the intensive care unit (ICU; group 2 n=48). When compared with the patients in group 2, those in group 1 had lower mean preoperative serum creatinine levels (0.9 +/- 1 vs 0.6 +/- 0.3 mg/dL, P=.04) and intraoperative transfusion requirements (packed red blood cells, 35.5 +/- 29.8 vs 25.6 +/- 19.0 mL/kg; P=.05, and fresh frozen plasma, 33.1 +/- 15.6 vs 25.7 +/- 14.3 mL/kg; P=.01). The incidence of intraoperative hypotension and emergent OLT was significantly greater in group 2 than group 1 (33.3% vs 13.5%, P=.01 and 45.8% vs 21.2%, respectively, P=.009). On logistic regression analysis, only emergent OLT (P=.009, odds ratio = 3.5) and intraoperative hypotension (P=.018, odds ratio = 3.7) were significantly associated with a lower probability of immediate postoperative extubation in the OR. Our results suggested that hemodynamic stability and elective OLT were predictors of successful immediate tracheal extubation in the OR.