Extubation delays and the associated prostaglandin and opiate dose following coarctation of the aorta repair

Abstract

BackgroundCoarctation of the aorta (COA) is one of the most common congenital heart lesions. Most patients undergoing repair extubate without complication. A subset of patients are unable to extubate within 24 h postoperatively. ObjectiveWe examined risk factors determined a priori and their association with delays in extubation. MethodsThis is a retrospective single-center study at an academic quaternary children's hospital. All neonates (0–28 days) who underwent isolated coarctation repair via lateral thoracotomy between January 2008 – December 2019 were included. Delay in extubation was defined as duration from cardiac intensive care unit admission to time of extubation >24 h. Risk factors examined were total preoperative prostaglandin dose and total perioperative opiate dose following repair. Logistic regression analyses were performed using appropriate statistics with significance level set at p = 0.05. ResultsThere were 149 patients who met inclusion criteria, 102 (68.5 %) were intubated for >24 h. We found that patients who were smaller (3.2 kg vs. 3.4 kg, p = 0.012) and patients who were in the intensive care unit preoperatively (p = 0.048), were more likely to remain intubated >24 h. There was also a statistically significant difference between those that were extubated before 24 h postoperatively and those that were not with respect to the total amount of oral morphine milligram equivalent received (1.5 mg vs. 2.82 mg, p = 0.005). ConclusionsOf the 149 patients in our study, the majority (102 patients, 68.5 %) were unable to be extubated within 24 h of surgery following coarctation repair via lateral thoracotomy. Risk factors for delayed extubation were smaller neonates and patients who received greater amounts of opiates.