Risk factors of delayed extubation after esophagectomy in the surgical intensive care unit

Esophageal cancer is a common malignant tumor of the digestive tract, for which esophagectomy, a high-risk surgery, is the main treatment. Certain features of esophageal cancer surgery may increase the uncertainty of postoperative extubation, and inappropriate timing for extubation after esophagectomy may result in serious complications. This study aimed to determine the incidence and risk factors of delayed extubation after esophagectomy in the surgical intensive care unit (SICU).

The study population included patients with esophageal cancer who were admitted to the SICU after undergoing transthoracic esophagectomy in one center from July 2023 to December 2023. In the SICU, patients who were extubated within 90 minutes were assigned to the early-extubation group, and those extubated after more than 90 minutes were assigned to the delayed-extubation group. The demographic characteristics, preoperative variables, intraoperative parameters, and postoperative variables were collected.

Of the 117 enrolled patients, there were 49 (41.9%) patients in delayed-extubation group, and compared to those in the early-extubation group, these patients had a longer operative duration (254.41±76.41 vs. 229.32±49.14 min; P=0.03), median higher colloid infusion volume {750 [interquartile range (IQR), 450-750] vs. 500 (IQR, 250-750) mL; P=0.01}, and a lower urine volume (1.79±0.9 vs. 2.36±1.41 mL/kg/h; P=0.01). Five patients received high-flow nasal cannula therapy sequentially after extubation, representing a higher proportion in the delayed-extubation group than that in the early-extubation group (10.2% vs. 1.5%; P=0.04). Compared to the early group, the delayed group had a higher hospitalization costs [10.74±3.15 vs. 9.8±1.46 (in CNY ¥10,000); P=0.04]. In the multivariate logistic regression analysis, the independent influencing factors for delayed extubation were intraoperative colloid infusion >500 mL [odds ratio (OR) =2.97; P=0.009] and per 1 mL/kg/h increasing in urine volume (OR =0.62; P=0.03).

Delayed extubation after esophagectomy was found to be common in the SICU and remained an important factor contributing to the increase in the incidence of adverse events and medical costs. Intraoperative colloid infusion and urine volume were associated with delayed extubation.