Key Predictors of Early Extubation: A Modifiable Parameter Influencing Complications and Outcomes after Congenital Cardiac Surgery

Abstract

Objectives: At our hospital, we follow a fast-track extubation protocol focused on multimodal analgesia and early extubation following congenital heart surgery. The objective of this study was to ascertain whether early extubation serves as a predictor for reducing the rates of reintubation, complications, and lengths of ICU and hospital stay following congenital heart surgery.

Methods: Data were collected prospectively from January 1, 2023, to December 31, 2023, including all patients undergoing cardiac surgery for congenital heart lesions by a single cardiac surgeon and anesthesiologist at our center. Participants were followed up from the time of admission to 30 days postoperatively. We performed univariate regression analysis to identify predictors of reintubation, a composite outcome, and length of ICU and hospital stay. Multivariate logistic regression models were built to evaluate the predictors for the above outcomes of interest.

Results: 65.49% of our patients were extubated within 6 hours of surgery. We found that extubating patients within 6 hours of surgery significantly lowers the odds of the composite outcomes (OR 5.21, CI 95%, 1.17-23.22, p < 0.001), reintubation (8.32,1.34-51.72, p = 0.02), prolonged ICU stay (OR 12.73, CI 95%, 2.72-59.66, p < 0.001) and prolonged hospital stay (OR 3.3, CI 95%, 1.3-8.5, p = 0.013) compared to those patients extubated beyond 6 hours. Additional common factors influencing these outcomes include patient age, RACHS-1 score, and the durations of CPB, surgery, anesthesia, and NIV.

Conclusions: Early extubation is a crucial modifiable parameter that has a significant influence on reduced complications, ICU stay, and hospital stay following congenital heart surgery.

Keywords: early extubation; enhanced recovery after pediatric cardiac surgery; pediatric cardiac anesthesia.