Abstract PR354

Abstract

Background & Objectives: Analysis of American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database has demonstrated that development of postoperative complications of pneumonia, AMI, and AKI are all associated with reintubation (OR 10 to 15) [1]. However, overall incidence of reintuabtion postoperatively and pre-operative patient and surgical risk factors for all surgeries is unclear. Postoperative pulmonary complications including reintubation within 48 hours can increase the cost of an admission from 2 to 12 fold, and it has been recommended that better risk stratification methods are developed [2]. Materials & Methods: Institutional Review Board approval was obtained. We collected data on all postoperative reintuabtion recorded in ACS-NSQIP 2007-2013 inclusive. We assessed for associations between demographics, patient, and surgical factors and reintubation using univariate and multivariate analysis (OR, 95% confidence interval). Results: Reintubation occurred in 31,131 patients (1.1%). Patients undergoing reintubation were significantly more likely to be; older (55.9 vs 66.6 years), be ASA Grade 3 vs ASA 2 (OR 4.72, CI 4.54-4.90) and be ASA 4 vs ASA 2 (OR 15.34, CI 14.71-16.0). Multivariate analysis demonstrated association between reintubation and total dependence for ADLs (3.36, CI 3.2- 3.52), pre-operative SIRS (3.47 (3.34- 3.6)), sepsis (3.95 (3.79-4.11)) or septic shock (4.76 (4.52- 5.020)). Compared to general surgery (63% of all reintuabtions) patients orthopedic, cardiac and urological surgery patients were less likely (OR= orthopedic 0.25 (0.24-0.27), cardiac 0.33 (0.31- 0.36), urological 0.33 (0.3-0.35)) whilst thoracic surgery patients were more likely to undergo reintubation (1.37 (1.28-1.46)). Conclusion: Postoperative reintubation demonstrates overall associations with age, thoracic surgery, but particularly with SIRS, sepsis and septic shock, even when case mix adjusted.