Disclosure: The authors do not have any disclosure of any personal or financial support and there is no actual or potential conflict of interest for the subject manner.
Quality Improvement Program Increases Early Tracheal Extubation Rate and Decreases Pulmonary Complications and Resource Utilization After Cardiac Surgery
Article first published online: 1 JUL 2009
© 2009 Wiley Periodicals, Inc.
Journal of Cardiac Surgery
Volume 24, Issue 4, pages 414–423, July 2009
How to Cite
Camp, S. L., Stamou, S. C., Stiegel, R. M., Reames, M. K., Skipper, E. R., Madjarov, J., Velardo, B., Geller, H., Nussbaum, M., Geller, R., Robicsek, F. and Lobdell, K. W. (2009), Quality Improvement Program Increases Early Tracheal Extubation Rate and Decreases Pulmonary Complications and Resource Utilization After Cardiac Surgery. Journal of Cardiac Surgery, 24: 414–423. doi: 10.1111/j.1540-8191.2008.00783.x
- Issue published online: 1 JUL 2009
- Article first published online: 1 JUL 2009
Abstract Background: Early tracheal extubation is a common goal after cardiac surgery and may improve postoperative outcomes. Our study evaluates the impact of a quality improvement program (QIP) on early extubation, pulmonary complications, and resource utilization after cardiac surgery. Methods: Between 2002 and 2006, 980 patients underwent early tracheal extubation (<6 hours after surgery) and 1231 had conventional extubation (> 6 hours after surgery, conventional group). Outcomes compared between the two groups included: (1) pneumonia, (2) sepsis, (3) intensive care unit (ICU) length of stay, (4) hospital length of stay, (5) ICU readmission, and (6) reintubation. Logistic regression analysis and propensity score adjustment were used to adjust for imbalances in the patients’ preoperative characteristics. Results: Early extubation rates were significantly increased with QIP (QIP 53% vs. Non-QIP 38%, p = 0.01). Early extubation was associated with a lower rate of (1) pneumonia (odds ratio [OR]= 0.35, 95% confidence intervals [CI]= 0.22–0.55, p <0.001), (2) sepsis (OR = 0.38, CI = 0.20–0.74, p <0.004), (3) prolonged ICU length of stay (OR = 0.42, CI = 0.35–0.50, p <0.001), (4) hospital length of stay (OR = 0.37, CI = 0.29–0.47, p <0.001), (5) ICU readmission (OR = 0.55, CI = 0.39–0.78, p <0.001), and (6) reintubation (OR = 0.53, CI = 0.34–0.81, p <0.003) both in multivariable logistic regression analysis and propensity score adjustment. Conclusions: QIP and early tracheal extubation reduce pulmonary complications and resource utilization after cardiac surgery.