Guller Ulrich, Anstrom Kevin J, Holman William L, Allman Richard M, Sansom Monique, Peterson Eric D
Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama, USA.
Ann Thorac Surg. 2004 Mar;77(3):781-8. doi: 10.1016/j.athoracsur.2003.09.059.
While early extubation after coronary artery bypass grafting (CABG) has been associated with resource savings, its effect on patient outcomes remains unclear. The goal of the present investigation was to evaluate whether early extubation can be performed safely in elderly CABG patients in community practice.
We studied 6,446 CABG patients, aged 65 years and older, treated at 35 hospitals between 1995 and 1998. Patients were categorized based on their post-CABG extubation duration (early, < 6 hours; intermediate, 6 to < 12 hours; and late, 12 to 24 hours). We compared unadjusted and risk-adjusted mortality, reintubation rates, and post-CABG length of stay (pLOS). We also examined the association between patients' intubation time and outcomes among patients with similar propensity for early extubation and among high-risk patient subgroups.
The overall mean post-CABG intubation time was 9.8 (SD 5.7) hours with 29% of patients extubated within 6 hours. After adjusting for preoperative risk factors patients extubated in less than 6 hours had significantly shorter postoperative hospital stays than those with later extubation times. Patients extubated early also tended to have equal or better risk-adjusted mortality than those with intermediate (odds ratio: 1.69, p = 0.08) or long intubation times (odds ratio: 1.97, p = 0.02). These results were consistent among patients with similar preoperative propensity for early extubation and among important high-risk patient subgroups. There was no evidence for higher reintubation rates among elderly patients selected for early extubation.
In community practice, early extubation after CABG can be achieved safely in selected elderly patients. This practice was associated with shorter hospital stays without adverse impact on postoperative outcomes.
虽然冠状动脉旁路移植术（CABG）后早期拔管与资源节约相关，但其对患者预后的影响仍不明确。本研究的目的是评估在社区医疗中，老年CABG患者能否安全地进行早期拔管。
我们研究了1995年至1998年间在35家医院接受治疗的6446例65岁及以上的CABG患者。根据CABG术后拔管时间对患者进行分类（早期，<6小时；中期，6至<12小时；晚期，12至24小时）。我们比较了未经调整和风险调整后的死亡率、再次插管率以及CABG术后住院时间（pLOS）。我们还研究了具有相似早期拔管倾向的患者以及高危患者亚组中患者的插管时间与预后之间的关联。
CABG术后总体平均插管时间为9.8（标准差5.7）小时，29%的患者在6小时内拔管。在对术前风险因素进行调整后，拔管时间少于6小时的患者术后住院时间明显短于拔管时间较晚的患者。早期拔管的患者在风险调整后的死亡率也往往与中期（优势比：1.69，p = 0.08）或长时间插管的患者相同或更好（优势比：1.97，p = 0.02）。这些结果在具有相似术前早期拔管倾向的患者以及重要的高危患者亚组中是一致的。没有证据表明选择早期拔管的老年患者再次插管率更高。
在社区医疗中，选定的老年患者在CABG术后可以安全地实现早期拔管。这种做法与缩短住院时间相关，且对术后预后没有不利影响。
