Associated Risk Factors and Complications in Vascular Surgery Patients Requiring Unplanned Postoperative Reintubation

Abstract

Objective: To determine the frequency of reintubation within 30 days in vascular surgery patients and the associated risk factors and complications.

Design: Retrospective cohort study with univariate and multivariate analyses of risk factors and outcomes from data collected by the American College of Surgeons National Surgical Quality Improvement Program.

Setting: All institutions participating in the American College of Surgeons National Surgical Quality Improvement Program.

Participants: All patients older than 18 undergoing vascular surgery.

Interventions: Not applicable.

Measurements and main results: A reintubation rate of 2.2% among vascular surgery patients within the first 30 days was demonstrated. Reintubation was associated positively with increased age, low body mass index, poor functional status, smoking status, chronic obstructive pulmonary disease, congestive heart failure, and increased anesthesia and surgical times. In addition, specific procedures were found to have significantly increased rates of reintubation, including bypass surgery, thrombectomy, and open thoracic and abdominal aorta surgery. Reintubation was associated positively with all measured complications, including a quadrupled length of average hospital stay (19.8 v 5.5 days), a 10-fold risk of mortality (33.9% v 2.6%), and a 40-fold risk of cardiac arrest (22.4% v 0.5%).

Conclusions: Patients undergoing major vascular surgery represent a high-risk population for unplanned postoperative reintubation. Preoperative evaluation should include the consideration of the positively associated risk factors found in this study. Due to the significant morbidity associated with unplanned reintubation, additional work is needed to identify risk factors amenable to optimization in the preoperative period.

Keywords: National Surgical Quality Improvement Program; outcomes; reintubation; risk factors; vascular surgery.