Early extubation effects on postoperative outcomes in high-risk abdominal surgery based on propensity score matching

It is unclear whether Early Extubation (EE) practices affect the patient outcomes after Acute High-risk Abdominal (AHA) surgery. This study aims to explore the impact of EE on the postoperative prognosis of AHA surgery patients. A screening and analysis were performed among 9219 patients who underwent AHA surgery from January 2012 to December 2019. After meeting the pre-determined extubation criteria, patients were divided into two groups: EE (≤ 4 h) and Delayed Extubation (DE) (< 4 h) according to the time of extubation. Various clinical indicators were compared between the EE and DE groups after propensity-score matching. Hospital stay was the primary outcome assessed. And multivariate and subgroup analyses were performed to identify independent predictors of hospital stay length. After propensity-score matching, a total of 1074 patients were enrolled, including 537 in the EE group and 537 in the DE group. A greater number of DE patients underwent laparotomy and used vasoactive drugs than EE patients (p < 0.001). Compared to the DE group, the EE group had significantly shorter intubation time (285 [IQR 225, 350] vs. 427[IQR 300, 514]), lower postoperative pulmonary infection rates, and considerably shorter hospital stay (12 [IQR 10, 16] vs. 14 [IQR 10, 19]) (p < 0.001). In stepwise multivariable analysis, EE status (BETA-2.075; 95%CI (-2.898, -1.217)) and postoperative pulmonary infection (BETA 0.401; 95%CI (-2.898, -1.217)) were identified as independent variables associated with a longer hospital stay. Furthermore, EE status were identified as independent variables associated with a longer hospital stay, in subgroups (various diagnosis, BMI and sex) analysis. Extubation within 4 h of meeting extubation criteria in AHA surgery was associated with improved postoperative outcomes, including reduced postoperative pulmonary infection, and a shorter hospital stay. However, prospective randomized controlled trials are needed to confirm the observed benefits and establish optimal timing for extubation.