Optimizing timing of early extubation in coronary artery bypass surgery patients

Background. This study was designed to assess the safety and efficacy of ex tubation performed within 4 hours of the patient's arrival in the surgical intensive care unit after coronary artery bypass graft surgery. Methods. A matched retrospective cohort study was performed including 412 c onsecutive patients undergoing isolated coronary artery bypass graft surger y between January 1996 and December 1997, constituting the experience of a single surgeon (J.H.L..). Early extubation (defined as extubation within 8 hours of arrival at the surgical intensive care unit) was achieved in 308 o f 412 patients (75%). Patients extubated in fewer than 4 hours after arriva l (n = 200) were compared with patients extubated within 4 to 8 hours (n = 108). Results. Four deaths occurred in 412 patients, for an overall operative mor tality rate of 1.0%. Patients extubated in fewer than 4 hours were younger than those extubated 4 or more hours after admission (62 versus 67 years ol d, respectively; p = 0.001), more likely to be male (74% versus 63%, p < 0. 05), and had shorter aortic cross-clamp times (49.4 +/- 15.0 versus 53.5 +/ - 14.0 minutes, p < 0.05) and cardiopulmonary bypass (CPB) times (65.2 +/- 18.6 versus 72.1 +/- 19.1 minutes, p < 0.05) compared to patients extubated later. Moreover, patients extubated in fewer than 4 hours had a shorter su rgical intensive care unit length of stay (33.8 +/- 25.7 versus 43.1 +/- 43 .0 hours, p < 0.05) and shorter postoperative length of stay (5.4 +/- 2.4 v ersus 6.2 +/- 2.6 days, p = 0.01) than those extubated later. Conclusions. Extubation in fewer than 4 hours may offer a substantial advan tage in terms of accelerated recovery compared with extubation within 4 to 8 hours. Very few differences in clinical parameters were noted between the two groups we studied, suggesting that efforts to reduce extubation times further might be worthwhile. (C) 2000 by The Society of Thoracic Surgeons.