SAFETY AND EFFICACY OF EARLY EXTUBATION OF ELDERLY CORONARY-ARTERY BYPASS-SURGERY PATIENTS

Objective: Early extubation and fast-track management protocols on you nger, low-risk patients result in shorter hospital stays and decreased costs. The impact of such protocols on elderly patients undergoing co ronary artery bypass graft (CABG) surgery is not presently known. Desi gn: A matched retrospective cohort study. Setting: A university teachi ng hospital. Participants: Six hundred ninety-eight consecutive patien ts undergoing isolated CABG between January 1995 and September 1996. I nterventions: Three hundred seventy-seven patients underwent early ext ubation, defined as extubation within 8 hours of arrival in the intens ive care unit. They were divided into groups of patients 70 years of a ge and younger (n =263) and patients older than 70 years of age (n = 1 14). Results: The mean length of stay (LOS) for all patients extubated within 8 hours or less was 5.5 days Versus 8.4 days for patients who underwent later extubation (p < 0.0001). The percentage of patients un dergoing early extubation was greater for the younger cohort (59% v 48 %; p < 0.003) compared with the older cohort of patients. Analysis of demographics showed the older patients to have a greater incidence of peripheral Vascular disease, congestive heart failure, and prior strok es (p < 0.05). Although the intensive care unit LOS was similar, posto perative LOS was 5.3 +/- 1.8 days for the younger patients versus 6.1 +/- 2.6 days for the older patients (p = 0.001). The overall surgical mortality rate was 2.6% (18/698), and there were no deaths among patie nts undergoing early extubation. Reintubation rate was negligible in b oth groups of patients.Conclusion: This study confirms the safety and efficacy of early extubation among elderly patients undergoing CABG. E lderly patients have more comorbid conditions, yet a significant numbe r can be extubated early, with resultant shortened LOSs. Copyright (C) 1998 by W.B. Saunders Company.