Factors Associated With 14-D Reintubation and Outcomes in Surgical Intensive Care Unit Patients

Reintubation after planned extubation is a clinically significant complication in surgical intensive care unit (SICU) patients, often indicating acute respiratory or systemic deterioration and leading to poor outcomes. However, SICU-specific data on its incidence and risk factors remain limited.

We conducted a retrospective cohort study of adult postoperative patients admitted to the SICUs of two tertiary medical centers in Taiwan (January 2009 to May 2024). Eligible patients underwent planned extubation following surgery. The primary outcome was reintubation within 14 d. Propensity score matching (1:4) based on age, sex, body mass index, and the Charlson comorbidity index was performed to reduce baseline imbalance. Associated factors were identified using multivariable logistic regression. Clinical outcomes were compared between groups.

Among 11,194 patients, 501 (4.5%) experienced reintubation. After matching, 491 reintubated patients were compared with 1964 controls. Factors independently associated with reintubation included transfer from the emergency room or another intensive care unit, higher Sequential Organ Failure Assessment scores, prolonged mechanical ventilation, total parenteral nutrition, vasopressor use, carbapenem exposure, lower PaO₂/FiO₂ ratio, tachycardia, hypoalbuminemia, renal dysfunction, abnormal liver function, and elevated international normalized ratio. Incentive spirometry or noninvasive ventilation were associated with lower odds of reintubation. Reintubation was associated with significantly longer intensive care unit and hospital stays, higher 30-d and in-hospital mortality, and increased health care costs (all P < 0.001).

In this large two-center SICU cohort, reintubation after planned extubation was associated with adverse outcomes and resource utilization. Early identification of high-risk features may enhance extubation readiness assessment, targeted monitoring, and preventive strategies.