Preoperative risk stratification identifies low-risk candidates for early extubation after aortocoronary bypass...

Early tracheal extubation has been the focus of recent attempts to accelerate the care of patients after aortocoronary bypass. Following the 1994 validation of a preoperative mortality risk mode based on the Society of Thoracic Surgeons National Cardiac Surgery Database, we examined the records of 328 aortocoronary bypass patients from our institution and identified 133 patients with low preoperative mortality risk. Their records were then analyzed for duration of tracheal intubation. One low-risk patient who did not survive was excluded from the analysis. Of the remaining 132 patients, 108 experienced no postoperative complications; nevertheless, 50 of these were intubated longer than 10 hours despite freedom from complications. In a 2nd group of 153 consecutive low-risk patients, we prospectively implemented a patient care protocol that designated low-risk patients as eligible for accelerated weaning. Compared were the 1st group, these patients with low preoperative mortality risk were weaned from mechanical ventilation in 40% less time. Thus, we found that low preoperative mortality risk predicts success in early tracheal extubation. Risk stratification appears to be a simple and useful means of identifying patients least likely to encounter postoperative complications. Risk-based accelerated recovery was successfully implemented without requiring a change in anesthetic or surgical management.