TY - JOUR
T1 - Outcomes of early extubation after bypass surgery in the elderly
AU - Guller, Ulrich
AU - Anstrom, Kevin J.
AU - Holman, William L.
AU - Allman, Richard M.
AU - Sansom, Monique
AU - Peterson, Eric D.
N1 - Funding Information:
We thank the Alabama CABG Cooperative Project Study Group and AQAF staff members for their important contributions to this project. Doctor Peterson was the recipient of a Paul Beeson Career Development Award administered by the American Federation for Aging Research and the Alliance for Aging Research. The authors thank the Swiss National Foundation, Bern/Switzerland, Krebsliga beider Basel, Basel/Switzerland, Freiwillige Akademische Gesellschaft, Basel/Switzerland, and Fondazione Gustav e Ruth Jacob, Aranno/Switzerland for their financial support of Dr Guller's research fellowship at the Duke University Medical Center.
Funding Information:
This analysis is based on the patient population from the Alabama Cooperative CABG project, which has been described in detail elsewhere [19, 20] . Briefly this quality improvement project was conducted by the Alabama Quality Assurance Foundation (AQAF), a Medicare Quality Improvement Organization designated and funded by the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration, to carry out statewide quality improvement initiatives. The project examined care and outcomes of bypass surgery during an initial study period (July 1, 1995, through June 30, 1996) and compared these with cases performed after a quality improvement initiative (July 1, 1998, through December 31, 1998). The study hospitals were located both in Alabama and a comparison state in which no interventions were performed. These analyses were completed after acquiring a waiver of consent from the Duke Institutional Review Board.
PY - 2004/3
Y1 - 2004/3
N2 - Background. While early extubation after coronary artery bypass grafting (CABG) has been associated with resource savings, its effect on patient outcomes remains unclear. The goal of the present investigation was to evaluate whether early extubation can be performed safely in elderly CABG patients in community practice. Methods. We studied 6,446 CABG patients, aged 65 years and older, treated at 35 hospitals between 1995 and 1998. Patients were categorized based on their post-CABG extubation duration (early, < 6 hours; intermediate, 6 to < 12 hours; and late, 12 to 24 hours). We compared unadjusted and risk-adjusted mortality, reintubation rates, and post-CABG length of stay (pLOS). We also examined the association between patients' intubation time and outcomes among patients with similar propensity for early extubation and among high-risk patient subgroups. Results. The overall mean post-CABG intubation time was 9.8 (SD 5.7) hours with 29% of patients extubated within 6 hours. After adjusting for preoperative risk factors patients extubated in less than 6 hours had significantly shorter postoperative hospital stays than those with later extubation times. Patients extubated early also tended to have equal or better risk-adjusted mortality than those with intermediate (odds ratio: 1.69, p = 0.08) or long intubation times (odds ratio: 1.97, p = 0.02). These results were consistent among patients with similar preoperative propensity for early extubation and among important high-risk patient subgroups. There was no evidence for higher reintubation rates among elderly patients selected for early extubation. Conclusions. In community practice, early extubation after CABG can be achieved safely in selected elderly patients. This practice was associated with shorter hospital stays without adverse impact on postoperative outcomes.
AB - Background. While early extubation after coronary artery bypass grafting (CABG) has been associated with resource savings, its effect on patient outcomes remains unclear. The goal of the present investigation was to evaluate whether early extubation can be performed safely in elderly CABG patients in community practice. Methods. We studied 6,446 CABG patients, aged 65 years and older, treated at 35 hospitals between 1995 and 1998. Patients were categorized based on their post-CABG extubation duration (early, < 6 hours; intermediate, 6 to < 12 hours; and late, 12 to 24 hours). We compared unadjusted and risk-adjusted mortality, reintubation rates, and post-CABG length of stay (pLOS). We also examined the association between patients' intubation time and outcomes among patients with similar propensity for early extubation and among high-risk patient subgroups. Results. The overall mean post-CABG intubation time was 9.8 (SD 5.7) hours with 29% of patients extubated within 6 hours. After adjusting for preoperative risk factors patients extubated in less than 6 hours had significantly shorter postoperative hospital stays than those with later extubation times. Patients extubated early also tended to have equal or better risk-adjusted mortality than those with intermediate (odds ratio: 1.69, p = 0.08) or long intubation times (odds ratio: 1.97, p = 0.02). These results were consistent among patients with similar preoperative propensity for early extubation and among important high-risk patient subgroups. There was no evidence for higher reintubation rates among elderly patients selected for early extubation. Conclusions. In community practice, early extubation after CABG can be achieved safely in selected elderly patients. This practice was associated with shorter hospital stays without adverse impact on postoperative outcomes.
KW - 18
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U2 - 10.1016/j.athoracsur.2003.09.059
DO - 10.1016/j.athoracsur.2003.09.059
M3 - Article
C2 - 14992871
AN - SCOPUS:1442324765
VL - 77
SP - 781
EP - 788
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 3
ER -