Factors Influencing Operating Room Extubation of Adults With Congenital Heart Disease Undergoing Cardiac Surgery: A...

This study aimed to (1) describe an institution's experience with extubating adults with congenital heart disease (ACHDs) in the operating room (OR), (2) identify factors associated with clinicians' decisions to extubate in the OR or return to the intensive care unit (ICU) intubated, and (3) evaluate the relationship between OR extubation, hospital length of stay, and 30-day hospital readmission in this population.

Retrospective cohort study.

A single pediatric congenital heart disease program within a quaternary care center.

A total of 172 ACHDs undergoing cardiac surgery between August 2018 and December 2025.

None.

(1) Among the 172 ACHDs undergoing cardiac surgery, 112 were extubated in the OR and 60 were extubated thereafter in the ICU. (2) Following multivariate adjustment, total operative time in minutes was most significantly associated with extubation after transfer to the ICU, and cardiopulmonary bypass time in minutes was used as a marker for operative length in the final model (adjusted odds ratio, 0.99; p < 0.0001). Notably, body mass index (BMI) was not associated with extubation in the OR (adjusted odds ratio, 0.94; p = 0.056), and univariate analysis indicated that patients extubated in the OR had similar BMIs overall (median 24.7 kg/m²) to those who were extubated in the ICU (median 25.9 kg/m², p = 0.259). (3) Overall, ACHDs extubated in the OR had a shorter hospital length of stay (β = 7.04, p = 0.103) and 30-day readmission rate (odds ratio, 0.34; p = 0.122), although neither relationship reached statistical significance after multivariate regression. The reintubation rate of patients extubated in the OR was 0.58% (1/172; 95% CI, 0.01%-3.2%) and 2.3% overall (4/172; 95% CI, 0.01%-3.2%).

Operative time in minutes had the strongest correlation with clinicians' decision to return to the ICU intubated. In this cohort of patients, the contribution of BMI to the decision not to extubate in the OR was clinically and statistically insignificant. This study shows that in-OR extubation of ACHDs has been performed in a medical center across a range of patient factors, including obesity, with very low rates of reintubation.