A Predictive Tool Using The Society of Thoracic Surgeons Risk Calculator for Safe Operating Room Extubation After...

Operating room extubation (ORE) after coronary artery bypass grafting (CABG) has proven benefit. However, predicting which patients should undergo ORE is difficult. We hypothesized that The Society of Thoracic Surgeons (STS) risk scores could be used as a predictive tool for ORE.

Between January 1, 2023 and November 30, 2025, the STS risk scores of 687 consecutive patients who underwent on-pump CABG were calculated. Risk scores for death (in-hospital or 30-day mortality), stroke (cerebrovascular accident), acute kidney injury (AKI), reoperation, prolonged ventilation, deep sternal wound infection, prolonged length of stay, and blood transfusions were used to generate the predictive model for ORE. Multivariate logistic regression analysis was used to determine which STS scores were independent predictors of ORE. A composite score, along with a receiver operating characteristic curve with area under the curve, were also generated.

Among the 687 patients, 289 (42%) underwent ORE, and 1 of 289 (0.3%) required reintubation. Multivariate analysis determined that the risk of prolonged ventilation <3% (odds ratio [OR], 1.62; P = .03; 95% CI, 1.06-2.46), the risk of in-hospital or 30-day mortality <0.5% (OR, 2.58; P < .01; 95% CI, 1.39-4.80), and the risk of AKI <2% (OR, 1.67; P = .05; 95% CI, 0.99--2.84) were all independently associated with successful ORE. The receiver operating characteristic and area under the curve documented that the model's performance was accurate 65% of the time. A composite score <7% favored ORE, whereas a composite score >25% favored FTE.

ORE is safe in selected patients undergoing CABG, particularly if ORE is practiced with high frequency and in patients with an STS calculator risk of prolonged ventilation <3%, in-hospital or 30-day mortality <0.5%, and AKI <2%.