Risks and outcomes of extubation failure after acute stanford Type A aortic dissection: a retrospective cohort study...

Extubation failure is a serious adverse event after cardiac surgery, particularly following acute Stanford type A aortic dissection (ATAAD) repair, with rates exceeding those after routine general anesthesia. This study aimed to identify risk factors and compare outcomes between patients who experienced extubation successfully and those who experienced extubation failure after ATAAD surgery.

We included consecutive patients admitted to the ICU following ATAAD surgery between January 2016 and December 2021. Using 1:1 propensity score matching (PSM) on the basis of patient characteristics and medical history, we compared matched cohorts with successful extubation and those with failed extubation. Receiver operating characteristic (ROC) curve analysis was used to identify optimal predictive thresholds. Both univariate and multivariable logistic regression analyses were performed to identify independent predictors of extubation failure. We analysed the reasons for extubation failure.

After PSM (18 patients per group), patients with extubation failure had higher preoperative APACHE II scores (12.89 ± 3.07 vs. 10.00 ± 1.94; P = 0.002) and GERAADA scores (25.14 ± 6.25 vs. 19.06 ± 10.81; P = 0.046). ROC analysis identified thresholds: APACHE II > 12.5 (AUC 0.744) and GERAADA > 21.9% (AUC 0.832); DeLong test P = 0.485. Multivariable analysis confirmed APACHE II as an independent predictor (OR = 1.66, P = 0.023). Among extubation failure patients, early reintubation (≤ 24 h) occurred in 5 (23.8%, primarily surgical complications) and late reintubation (> 24 h) in 16 (76.2%, predominantly pulmonary infection/secretion retention). No significant differences were observed in preoperative/peri-extubation oxygenation, carbon dioxide retention, ICU stay, or mortality rates between groups.

Preoperative APACHE II score > 12.5 and GERAADA score > 21.9% may identify patients at increased risk of extubation failure after ATAAD surgery. Given that delayed failure was primarily driven by impaired airway clearance, post-extubation management should prioritize airway clearance strategies alongside conventional oxygen support. These exploratory findings require prospective validation.