Abstract 14448: On-Table Extubation Associated With Lower Resource Utilization and Non-Inferior Outcomes After Coronary Bypass

Abstract

Introduction: Minimizing the duration of postoperative ventilation facilitates early discharge from the intensive care unit (ICU) thus promoting enhanced recovery after cardiac surgery (ERAS). Hence, we sought to investigate the impact of on-table extubation on outcomes and resource utilization after coronary artery bypass graft (CABG) surgery. Methods: We performed a retrospective review of a prospectively collected local database, including all patients undergoing CABG surgery at a large academic center from January 2020 to December 2021. Patients were stratified into two groups, on-table (before leaving the operating room) extubation versus early (< 6 hours after procedure) extubation. In-hospital mortality and postoperative complications were compared using univariate analyses. Length of stay (LOS), 30-day readmission and high resource utilization (HRU), a binary outcome defined as direct procedure cost of the highest quartile, were investigated. Results: A total of 691 patients were included in our analysis, 267 (38.6%) of which were extubated on-table. The two groups had similar median age and preoperative ejection fractions. However, on-table extubation patients were more likely to be males (86.9% vs 76.6%, p<0.001) with smaller BMIs (27.7% vs 28.5%, p=0.002), lower STS risk scores (0.75% vs 0.95%, p=0.022) and lower cerebrovascular disease prevalence (8.2% vs 14.2%, p=0.017). Compared to early extubation, on-table extubation patients had similar rates of in-hospital mortality (0 % vs 1.4 %, p=0.051), postoperative blood transfusion (7.5% vs 9.0%, p=0.494), reintubation (2.6% vs 3.5%, p=0.499) and pneumonia (1.9% vs 3.3%, p=0.263). As hypothesized, on-table extubation patients had shorter ICU LOS (32hrs vs 39hrs, p=0.02), shorter postoperative LOS (4.9 days vs 5.9 days, p=0.003), and lower incidence of high resource utilization (18.0% vs 29.5%, p<0.001). ICU readmission (3.8% vs 3.5%, p=0.887) and 30-day readmission (5.2% vs 7.3%, p=0.277) were similar in the two groups. Conclusions: On-table extubation is a safe and effective ERAS practice, that is associated with lower ICU LOS, postoperative LOS, and resource utilization, without affecting rates of reintubation, ICU readmission, 30-day readmission or operative mortality.