Effects of on-table extubation on resource utilization and maternal anxiety in children undergoing congenital heart surgery in a low-resource environment
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Updated: Jun 25, 2025
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Published on: June 2, 2022
Kaushik Jothinath1, Vijayakumar Raju2, Michael E Nemergut3
1Department of Cardiac Anesthesiology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India.
Insights
On-table extubation after pediatric heart surgery shortens intensive care unit and hospital stays, reducing costs and maternal anxiety. However, it increases anxiety for intensive care unit nurses caring for these patients.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Health Economics
Background:
- Implementing on-table extubation (OTE) protocols in low-resource settings for congenital cardiac surgery presents unique challenges.
- Assessing the impact of OTE on patient outcomes and healthcare costs is crucial for resource allocation.
Purpose of the Study:
- To evaluate the feasibility and impact of an on-table extubation (OTE) protocol following congenital cardiac surgery in a low-resource environment.
- To determine OTE's effect on intensive care unit (ICU) and hospital stay duration, hospitalization costs, and anxiety levels in mothers and nurses.
Main Methods:
- A prospective, nonrandomized, observational study included 60 children over 1 year old undergoing congenital cardiac surgery.
- Children were assessed for OTE feasibility post-cardiopulmonary bypass, divided into OTE and postoperative ventilation groups.
- Data collected included hospital/ICU stay, costs, and State Trait Anxiety Inventory (STAI) scores for mothers and ICU nurses.
Main Results:
- On-table extubation significantly reduced ICU stay (median 20h vs. 22h) and hospital costs (median USD 1970 vs. USD 2464).
- Maternal anxiety was significantly lower in the OTE group (STAI 36.5 vs. 47.4).
- Conversely, ICU nurse anxiety was significantly higher in the OTE group (STAI 46.0 vs. 37.8).
Conclusions:
- On-table extubation following pediatric congenital heart surgery is feasible and beneficial in low-resource settings.
- OTE leads to shorter ICU and hospital stays, reduced healthcare costs, and decreased maternal anxiety.
- Increased anxiety among ICU nurses managing OTE patients requires further attention and support strategies.
Objective:
To study the applicability of on-table extubation (OTE) protocol following congenital cardiac surgery in a low-resource setting and its impact on the length of intensive care unit (ICU) stay, hospital stay, hospitalization cost, parental anxiety, and nurse anxiety.
Materials And Methods:
In this prospective, nonrandomized, observational single-center study, we included all children above 1 year of age undergoing congenital cardiac surgery. We evaluated them for the feasibility of OTE using a prespecified protocol following separation from cardiopulmonary bypass. The data were prospectively collected on 60 children more than 1 year of age, belonging to the Risk Adjustment for Congenital Heart Surgery 1, 2, 3, and 4 groups and divided into two groups: those who underwent successful OTE and those who were ventilated for any duration postoperatively (30 children in each group). Duration of hospital stay, ICU stay, and total hospital cost were collected. Anxiety levels of the primary caregiver (nurse) in the ICU and the mother were assessed immediately after the arrival of the child in the ICU using the State Trait Anxiety Inventory (STAI).
Results:
Children who were extubated immediately following congenital cardiac surgery had significantly shorter ICU stay (median 20 [19, 22] h vs. 22 [20, 43] h [P < 0.05]). Patients extubated on table had a significant reduction in hospital cost {median Rs. 161,000 (138,330; 211,900), approximately USD 1970 (P < 0.05)} when compared to children who were ventilated postoperatively {median Rs. 201,422 (151,211; 211,900) , approximately USD 2464}. The anxiety level in mothers was significantly less when their child was extubated in the operating room (STAI 36.5 ± 5.4 vs. 47.4 ± 7.4, P < 0.001). However, for the same subset of patients, anxiety level was significantly higher in the ICU nurse (STAI 46.0 ± 5.6 vs. 37.8 ± 4.1, P < 0.05).
Conclusion:
OTE following congenital cardiac surgery is associated with a shorter duration of ICU stay and hospital stay. It also reduces the total hospital cost and the anxiety level in mothers of children undergoing congenital heart surgery. However, the primary bedside caregiver during the child's ICU stay had increased anxiety managing patients with OTE.
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