Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Karamanos, Efstathios; Schmoekel, Nathan; Blyden, Dionne; Falvo, Anthony; Rubinfeld, Ilan

doi:10.7812/tpp/16-017

Cited by 12 publications

(16 citation statements)

References 16 publications

(18 reference statements)

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“…This study reports a 1.6% incidence of unplanned postoperative reintubation (UPR), which is comparable to the range of 0.4%–4% reported by other studies [ [3] , [4] , [5] , [6] , [11] , [12] , [13] , [14] , [15] ]. Consistent with previous studies [ [1] , [2] , [3] , [4] , [5] , [6] ], the present study also identified UPR to be significantly associated with morbidity and mortality. UPR was associated with increased mortality, wound infection, postoperative RBC transfusion, prolonged hospitalization, pulmonary, renal, cardiac and thrombotic complications.…”

Section: Discussionsupporting

confidence: 92%

“…Unplanned postoperative reintubation (UPR) is therefore an unexpected event that indicates an unfavorable postoperative course. It serves as a marker for severe adverse outcome after surgery, and is associated significant morbidity, mortality and healthcare cost [ [1] , [2] , [3] , [4] , [5] , [6] ]. Indications for UPR have ranged from unexpected or failed extubation to clinical deterioration of patients after surgery [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Unplanned postoperative reintubation following general and vascular surgical procedures: Outcomes and risk factors

Acheampong

Guerrier

Lavarias

et al. 2018

Annals of Medicine and Surgery

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BackgroundUnplanned postoperative reintubation (UPR) is a marker for severe adverse outcomes following general and vascular surgery.Study designA retrospective analysis of 8809 adult patients, aged 18 years and older, who underwent major general and vascular surgery at a large single-center urban hospital was conducted from January 2013 to September 2016. Patients were grouped into those who experienced UPR and those who did not. Univariate and multivariate regression analyses were used to identify predictors of UPR, and association of UPR with adverse postoperative outcomes. All regression models had Hosmer-Lemeshow P > 0.05, and C-statistic >0.75, indicating excellent goodness-of-fit and discrimination.ResultsOf the 8809 patients included, 138 (1.6%) experienced UPR. There was no statistical difference in incidence of UPR between general and vascular surgery patients (p = 0.53). Independent predictors of UPR advanced age (OR 5.1, 95%CI 3.5–7.5, p < 0.01), higher ASA status (OR 7.9, 95%CI 5.6–11.1, p < 0.01), CHF (OR 7.0, 95%CI 3.6–13.9, p = 0.02), acute renal failure or dialysis (OR 3.1, 95%CI 1.8–5.7, p = 0.01), weight loss (OR 5.2, 95%CI 2.8–9.6, p = 0.01), systemic sepsis (OR 4.8, 95%CI 3.4–6.9, p < 0.01), elevated preoperative creatinine (OR 4.2, 95%CI 3.0–5.9, p = 0.01), hypoalbuminemia (OR 5.3, 95% CI 3.8–7.5, p = 0.01), and anemia (OR 4.0, 95%CI 2.8–5.9, p < 0.01). Following surgery, UPR was associated with increased mortality (OR 3.8, 95%CI 2.7–5.2, p < 0.01), pulmonary complications (OR 1.8, 95%CI 1.7–2.0, p < 0.01), renal complications (OR 2.6, 95%CI 1.7–3.5, p < 0.01), cardiac complications (OR 4.6, 95%CI 2.0–6.7, p < 0.01), postoperative RBC transfusion (OR 5.7, 95%CI 3.8–8.6,p < 0.01), and prolonged hospitalization (OR 1.8, 95%CI 1.5–2.4, p < 0.01).ConclusionUPR is significantly associated with postoperative morbidity and mortality. Perioperative management aimed at decreasing incidences of UPR after noncardiac surgery should target preoperative anemia in addition to previously identified predictors.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Unplanned postoperative reintubation following general and vascular surgical procedures: Outcomes and risk factors

Acheampong

Guerrier

Lavarias

et al. 2018

Annals of Medicine and Surgery

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“… 18 A patient's mFI is calculated as the number of variables present in a patient's medical history from the total 11 variables. 19 Patients with mFI scores ≥4 were grouped together to prevent variability associated with small group sizes. Patients without mFI variables were scored as 0 and included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population

Akyar

Armenia

Ratnani

et al. 2018

Surg J

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Background The burden of frail patients undergoing emergency general surgery (EGS) is increasing rapidly and this population is particularly susceptible to postoperative cardiopulmonary complications and mortality. We aimed to determine the association between frailty, as defined by the previously described modified frailty index (mFI), and postoperative respiratory complications (unplanned reintubation, pneumonia, and prolonged ventilation), cardiac complications (myocardial infarction and cardiac arrest), and mortality. We also sought to identify the most significant determinants of frailty in the highest risk patients based on the specific variables comprising the mFI. Methods We performed a retrospective observational analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Files from 2005 to 2015 identified 132,765 inpatients who underwent EGS. mFI scores were calculated for each patient. The effect of increasing frailty on unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality was evaluated using bivariate analysis. Multivariable logistic regression was used to compare mFI with additional predictor variables including race, gender, physical status as defined by the American Society of Anesthesiologists, disseminated cancer, renal failure, smoking status, sepsis, wound presence/classification, dyspnea, and previous ventilator dependence. Results Unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality were significantly associated with frailty, and the odds of each postoperative complication increased with increasing mFI score. Of the frailest patients (mFI ≥3) that experienced cardiopulmonary complications or mortality, the variables of the mFI that contributed most to frailty were hypertension requiring medication and functional status before surgery. Conclusions A higher mFI score is associated with increased odds of postoperative cardiopulmonary complications and mortality in the EGS population. Specific variables of the mFI can also provide valuable information for assessing odds in the frailest patients undergoing EGS.

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“…Several strategies have the potential to minimize the high risk of unplanned reintubation in patients with morbid obesity and/or COPD, in turn associated with higher mortality, longer ICU course, increased incidence of nosocomial pneumonia and increased risk of transfer to long-term care facilities [ 165 – 168 ]. Incentive spirometry and aggressive chest physiotherapy should be instituted in the immediate postoperative stage [ 169 ].…”

Section: Minimizing the Risks Of Postoperative Reintubation In Neurosmentioning

confidence: 99%

Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications

Algahtani

Merenda

2020

Neurocrit Care

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With increasing prevalence of chronic diseases, multimorbid patients have become commonplace in the neurosurgical intensive care unit (neuro-ICU), offering unique management challenges. By reducing physiological reserve and interacting with one another, chronic comorbidities pose a greatly enhanced risk of major postoperative medical complications, especially cardiopulmonary complications, which ultimately exert a negative impact on neurosurgical outcomes. These premises underscore the importance of perioperative optimization, in turn requiring a thorough preoperative risk stratification, a basic understanding of a multimorbid patient's deranged physiology and a proper appreciation of the potential of surgery, anesthesia and neurocritical care interventions to exacerbate comorbid pathophysiologies. This knowledge enables neurosurgeons, neuroanesthesiologists and neurointensivists to function with a heightened level of vigilance in the care of these high-risk patients and can inform the perioperative neuro-ICU management with individualized strategies able to minimize the risk of untoward outcomes. This review highlights potential pitfalls in the intra-and postoperative neuro-ICU period, describes common preoperative risk stratification tools and discusses tailored perioperative ICU management strategies in multimorbid neurosurgical patients, with a special focus on approaches geared toward the minimization of postoperative cardiopulmonary complications and unplanned reintubation.

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Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Cited by 12 publications

References 16 publications

Unplanned postoperative reintubation following general and vascular surgical procedures: Outcomes and risk factors

Unplanned postoperative reintubation following general and vascular surgical procedures: Outcomes and risk factors

The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population

Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications

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