Operating Room Extubation may not Increase Postoperative Delirium or Reintubation Rates, but Reduces Intubation Duration: Study

Written by Dr Monish Raut Published On 2025-01-15T08:45:36+05:30 | Updated On 15 Jan 2025 10:55 AM IST

Operating Room Extubation may not Increase Postoperative Delirium or Reintubation Rates, but Reduces Intubation Duration: Study

Postoperative delirium is frequently seen in cardiac surgery patients, affecting as many as 52% of individuals undergoing these procedures. Moreover, delirium following cardiac surgery is strongly linked to prolonged ICU stays, higher hospital costs, and even long-term mortality spanning up to a decade. Recent study examined the safety and feasibility of implementing an operating room (OR) extubation protocol for patients undergoing minimally invasive cardiac valve surgery. The researchers conducted a single-center retrospective chart review of 312 patients who underwent valvular surgery via thoracotomy between November 2017 and October 2022.

Comparison of Outcomes and Factors Analysed

The study compared outcomes before and after implementation of the OR extubation protocol, which was initiated on August 20, 2020. Delirium rates, reintubation rates, and intubation duration were assessed. Logistic regression was used to identify patient perioperative characteristics associated with unsuccessful OR extubation.

Patient Distribution and Characteristics

Of the 312 patients, 254 were extubated in the intensive care unit (ICU) and 58 in the OR. Preoperative demographics were generally similar between the two groups, except the OR extubation group had a lower median Charlson Comorbidity Index (1.5 vs 2.0).

Analysis and Post-implementation Findings

Interrupted time series analysis showed no significant change in postoperative delirium rates after implementation of the OR extubation protocol, with a trend towards decreasing delirium (risk ratio = 0.37, 95% CI: 0.13-1.10, p=0.07). The post-implementation era also had a lower median intubation duration (8 hours vs 13 hours, p<0.001) without increasing reintubation rates (1.7% vs 7.9%, p=0.159). Factors associated with decreased odds of successful OR extubation included increased bypass length (OR=0.99, 95% CI: 0.98-0.99, p<0.001), higher intraoperative morphine milligram equivalents (OR=0.99, 95% CI: 0.99-1.0, p=0.009), and a preoperative Charlson Comorbidity Index above 3 (OR=0.42, 95% CI: 0.19-0.95, p=0.037). In conclusion, implementation of an OR extubation protocol for minimally invasive cardiac valve surgery was not associated with increased postoperative delirium or reintubation rates, but did decrease intubation duration. Successful OR extubation appears to depend on consideration of various patient perioperative characteristics.

Key Points

1. The study examined the safety and feasibility of implementing an operating room (OR) extubation protocol for patients undergoing minimally invasive cardiac valve surgery.

2. The study compared outcomes before and after implementation of the OR extubation protocol, including delirium rates, reintubation rates, and intubation duration.

3. Of the 312 patients, 254 were extubated in the intensive care unit (ICU) and 58 in the OR. The OR extubation group had a lower median Charlson Comorbidity Index.

4. Interrupted time series analysis showed no significant change in postoperative delirium rates after implementation of the OR extubation protocol, with a trend towards decreasing delirium. The post-implementation era also had a lower median intubation duration without increasing reintubation rates.

5. Factors associated with decreased odds of successful OR extubation included increased bypass length, higher intraoperative morphine milligram equivalents, and a preoperative Charlson Comorbidity Index above 3.

6. Implementation of an OR extubation protocol for minimally invasive cardiac valve surgery was not associated with increased postoperative delirium or reintubation rates, but did decrease intubation duration. Successful OR extubation appears to depend on consideration of various patient perioperative characteristics.

Reference –

Chen Chia Wang et al. (2024). Safe Landing: Feasibility And Safety Of Operating Room Extubation In Minimally Invasive Cardiac Valve Surgery.. *Journal Of Cardiothoracic And Vascular Anesthesia*.https://doi.org/10.1053/j.jvca.2024.09.014

operating room extubationsuccessful operating room extubationminimally invasive cardiac surgerypostoperative deliriumintubation durationreintubation rates

Dr Monish Raut

MBBS, MD (Anaesthesiology), FNB (Cardiac Anaesthesiology)

Dr Monish Raut is a practicing Cardiac Anesthesiologist. He completed his MBBS at Government Medical College, Nagpur, and pursued his MD in Anesthesiology at BJ Medical College, Pune. Further specializing in Cardiac Anesthesiology, Dr Raut earned his FNB in Cardiac Anesthesiology from Sir Ganga Ram Hospital, Delhi.