Routine Extubation in the Operating Room After Isolated Coronary Artery Bypass

Area of Science:

• Cardiothoracic Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Fast-track extubation in the intensive care unit (ICU) post-cardiac surgery is beneficial.
• Extubation in the operating room (OR) is safe for select patients, but its widespread use in cardiac surgery is not well-established.
• This study evaluated perioperative outcomes of OR versus ICU extubation for nonemergency isolated coronary artery bypass grafting (CABG).

Purpose of the Study:

• To compare perioperative outcomes between operating room (OR) and intensive care unit (ICU) extubation in patients undergoing nonemergency isolated coronary artery bypass grafting (CABG).
• To assess the feasibility and safety of routine OR extubation for a broader patient population undergoing CABG.

Main Methods:

• Analysis of Society of Thoracic Surgeons (STS) data for single-center patients undergoing nonemergency isolated CABG over a 6-year period (2017-2022).
• Comparison of perioperative morbidity and mortality between ICU and OR extubation groups.
• Propensity score matching was used to create comparable cohorts for analysis.

Main Results:

• In the propensity-matched cohort (414 pairs), no significant differences were observed in reintubation, reoperation for bleeding, operative time, stroke, renal failure, or 30-day mortality between OR and ICU extubation groups.
• Operating room (OR) extubation was associated with shorter ICU hours (14 vs. 20 hours), reduced postoperative hospital length of stay (3 vs. 5 days), higher direct-to-home discharge rates (97.3% vs. 89.9%), and lower 30-day readmission rates (1.7% vs. 4.1%).
• These outcomes were statistically significant (P < .0001 for most, P = .04 for readmission).

Conclusions:

• Routine extubation in the operating room (OR) is a safe and feasible strategy for a wide range of patients after nonemergency coronary artery bypass grafting (CABG).
• This approach does not increase perioperative morbidity or mortality.
• Wider adoption of routine OR extubation for nonemergency CABG is recommended.