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.