Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Perianesth Nurs. 2023 Dec;38(6):912-917.e1. doi: 10.1016/j.jopan.2023.03.004. Epub 2023 Aug 31.
To investigate the incidence and outcome of reintubation after planned extubation (RAP) in the postanesthesia care unit (PACU) in China.
A single-center, retrospective, 1:2 matched cohort study following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.
Among 121,965 patients in the PACU, 14 patients with RAP were included in this study from January 1, 2017 to December 31, 2019. PACU length of stay, postoperative length of stay in hospital, inpatient healthcare costs, and outcomes were compared between the RAP and the matched groups.
The incidence of RAP was 0.0115%. After propensity score matching, there were no statistically significant differences in age, sex, body mass index (BMI), elective/nonelective procedure, surgical classification, American Society of Anesthesiologists physical status, the duration of anesthesia, or the duration of surgical procedure between the two groups. PACU length of stay, postoperative length of stay in hospital, and inpatient healthcare costs significantly differed between the RAP group and the matched group (P < .01 for all). The percentage of patients with longer PACU length of stay in the RAP group was significantly higher than that in the matched group (92.86% vs 7.14%), with an odds ratio of 29.87 (95% confidence interval = 14.00-2,040.54, P < .001).
Despite its low incidence, RAP in the PACU may be associated with life-threatening and severe complications with longer PACU length of stay, unexpected intensive care unit admission, longer hospitalization length, longer postoperative length of stay in hospital, and increased inpatient health costs. Appropriate timing of extubation and monitoring in the PACU can effectively prevent the occurrence of RAP and improve patient prognosis.
调查中国麻醉后恢复室（PACU）中计划性拔管后再插管（RAP）的发生率和结局。
一项单中心、回顾性、按 1:2 匹配队列研究，遵循《加强观察性研究的报告：流行病学（STROBE）声明》。
在 PACU 的 121965 名患者中，本研究纳入了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间 14 例 RAP 患者。比较 RAP 组和匹配组之间 PACU 停留时间、术后住院时间、住院医疗费用和结局。
RAP 的发生率为 0.0115%。经倾向评分匹配后，两组间在年龄、性别、体重指数（BMI）、择期/非择期手术、手术分类、美国麻醉医师协会身体状况、麻醉持续时间或手术持续时间方面均无统计学差异。RAP 组与匹配组的 PACU 停留时间、术后住院时间和住院医疗费用差异有统计学意义（均 P<.01）。RAP 组 PACU 停留时间延长的患者比例明显高于匹配组（92.86% vs 7.14%），优势比为 29.87（95%置信区间为 14.00-2040.54，P<.001）。
尽管 RAP 发生率较低，但 PACU 中的 RAP 可能与危及生命和严重并发症相关，表现为 PACU 停留时间延长、意外入住重症监护病房、住院时间延长、术后住院时间延长和住院医疗费用增加。在 PACU 中适时拔管和监测可有效预防 RAP 的发生，改善患者预后。
