Dexter Franklin, Marian Anil A, Epstein Richard H
Department of Anesthesia, Division of Management Consulting, University of Iowa, 200 Hawkins Drive, 6-JCP, Iowa, IA, 52242, USA.
Department of Anesthesiology, Perioperative Medicine and Pain Management, 1611 NW 12, University of Miami, Miami, FL, 33136, USA.
BMC Anesthesiol. 2025 Jan 4;25(1):4. doi: 10.1186/s12871-024-02862-6.
Prolonged tracheal extubation time is defined as an interval ≥ 15 min from the end of surgery to extubation. An earlier study showed that prolonged extubations had a mean 12.4 min longer time from the end of surgery to operating room (OR) exit. Prolonged extubations usually (57%) were observed during OR days with > 8 h of cases and turnovers, such that longer OR times from prolonged extubation can be treated as a variable cost (i.e., each added minute incurs an expense). The current study addressed limitations of the generalizability of these earlier investigations.
The retrospective cohort study included cases performed at a university hospital October 2011 through June 2023 with general anesthesia, tracheal intubation and extubation in the OR where the anesthetic was performed, and non-prone positioning. The primary endpoint was the interval from end of surgery to OR exit. Mean OR time differences with/without prolonged extubation were analyzed pairwise by surgeon. The variance among surgeons was estimated using the DerSimonian-Laird method with Knapp-Hartung adjustment for the sample sizes of surgeons. Proportions were analyzed after arcsine transformation, and the inverse taken to report results.
There were prolonged extubations for 23% (41,768/182,374) of cases. Prolonged extubations had a mean 13.3 min longer time from the end of surgery to OR exit (95% confidence interval 12.8-13.7 min, P < 0.0001). That result was among the 71 surgeons each with ≥ 9 cases having prolonged extubation times and ≥ 9 cases with typical extubation times. Results were similar using a threshold of ≥ 3 cases, comprising 257 surgeons (13.2 min, P < 0.0001). Among the 71 surgeons with at least nine prolonged extubations, on most days with a prolonged extubation during at least one of their cases, there were > 8 h of cases and turnover times in the OR (77%, 73%-81%, P < 0.0001). Results were similar when analyzed for the 249 surgeons each with ≥ 3 cases with prolonged extubation (76%, P < 0.0001).
Matching earlier findings, prolonged tracheal extubation times are important economically, increasing OR time by 13 min and usually performed in ORs with lists of cases of sufficient duration to treat the extra time as a variable cost.
气管拔管时间延长定义为从手术结束到拔管的间隔时间≥15分钟。一项早期研究表明，延长拔管时间的患者从手术结束到离开手术室（OR）的平均时间长12.4分钟。延长拔管通常（57%）出现在手术日手术和周转时间>8小时的情况下，因此延长拔管导致的手术室时间延长可视为可变成本（即每增加一分钟都会产生费用）。本研究解决了这些早期调查在可推广性方面的局限性。
这项回顾性队列研究纳入了2011年10月至2023年6月在一家大学医院进行的病例，这些病例在实施麻醉的手术室进行全身麻醉、气管插管和拔管，且采用非俯卧位。主要终点是从手术结束到离开手术室的间隔时间。由外科医生对有/无延长拔管的平均手术室时间差异进行成对分析。使用DerSimonian-Laird方法并根据外科医生的样本量进行Knapp-Hartung调整来估计外科医生之间的方差。对比例进行反正弦变换后分析，并取其倒数来报告结果。
23%（4,1768/182,374）的病例存在拔管时间延长。拔管时间延长的患者从手术结束到离开手术室的平均时间长13.3分钟（95%置信区间12.8 - 13.7分钟，P < 0.0001）。该结果来自71位外科医生，每位医生至少有9例拔管时间延长的病例以及至少9例拔管时间正常的病例。使用≥3例的阈值时结果相似，涉及257位外科医生（13.2分钟，P < 0.0001）。在至少有9例拔管时间延长的71位外科医生中，在其至少有一例拔管时间延长的大多数日子里，手术室的手术和周转时间>8小时（77%，73% - 81%，P < 0.0001）。对249位至少有3例拔管时间延长病例的外科医生进行分析时结果相似（76%，P < 0.0001）。
与早期研究结果一致，气管拔管时间延长在经济上很重要，会使手术室时间增加13分钟，且通常发生在手术安排时间足够长的手术室，以便将额外时间视为可变成本。
Zotero 插件