Incidence and Outcome of Reintubation in the Postanesthesia Care Unit: a Single-center, Retrospective, Observational Matched Cohort Study in China

Abstract

Backgroundː Reintubation after planned extubation (RAP) is a serious adverse event. This study aimed to determine the rate and impact of RAP on postoperative course and hospitalization outcomes.Methodsː Of the 121,965 patients in the PACU, 14 patients with RAP were included in this retrospective, single-center, 1:2 matched cohort study in China from January 1, 2017 to December 31, 2019. Duration of PACU stay, postoperative time in the hospital, inpatient healthcare costs, and outcome of hospitalization were compared between the RAP and matched groups.Resultsː The rate of RAP occurrence was 0.0115%. After propensity score matching, there were no statistically significant differences in age, sex, body mass index, emergency operation, surgical classification, American Society of Anesthesiologists physical status, and the durations of anesthesia and the procedure between the two groups. Duration of PACU stay, length of postoperative stay, and inpatient healthcare costs significantly differed between the RAP and matched groups (P < 0.01 for all). The percentage of patients in whom discharge from the PACU was prolonged was significantly higher in the RAP group than in the matched group (92.86% vs.714%), with an odds ratio of 29.87 (95% CI = 14.00 to 2040.54; P < 0.001) after matching.Conclusionsː RAP in the PACU had low incidence but was associated with life-threatening and serious complications, increased incidence of prolonged discharge, prolonged PACU and postoperative hospital stay, increased inpatient healthcare costs, and unanticipated intensive care unit admission. Hypoxemia, airway obstruction, dyspnea, respiratory depression, confusion, asthma, chest tightness, pain, hemorrhage, or agitation could be the risk factor for RAP. The appropriate time for tracheal extubation and monitoring in PACU can effectively prevent the occurrence of reintubation and improve the prognosis of patients.