A comparative study of immediate and late extubation after open heart surgery

Background: Cardiovascular surgery provides especial challenges, and specific conditions, for optimizing the weaning process. Earlier extubation after heart operations was shown to be both safe and cost-effective. Early extubation is performed 1 and 6 hours after arrival in the Intensive Care Unit (ICU) and associated with shorter ICU stays, and accordingly lower costs. The present retrospective study was conducted to assess immediate and early extubations in regard to postoperative complications, and cost-effectiveness in patients undergoing open cardiac surgeries. Patients and Methods: The medical records of 2126 patients who had undergone cardiac operation between March 2003 and February 2005 were reviewed in relation to two distinctive extubation protocols. Group A consisted of 1833 patients undergoing either immediate or early extubation. Group B comprised 293 patients who underwent late extubation. Four major types of surgeries were performed in patients. Results: Among 2126 patients, 71.8% were male and 28.2% were female. There were no significant differences in risk factors between the two groups. The mean age of patients in group A was 56±13, and in group B 50±17 years. Extubation time in group A was 2.06 hours compared with 13.22 hours in group B (P < 0.05). The mean of post-op bleeding in the first 12 hours between the two groups did not differ significantly, and were 482.4 and 426.4 ml respectively (P > 0.05). Reintubation had been performed in 2.6% of group A and 1.6% of group B, a difference that was not significant (P > 0.0 5). The mean ICU stay in group A and B were 2.79 and 3.42 days, respectively (P < 0.05). The respective mortality in groups A and B were 2 % and 4.7% (P < 0.05). Conclusion: Immediate extubation after open heart surgery can be performed safely for most of the patients. This would probably lead to a decrease in costs and prevent artificial ventilation problems without increasing post-op complications. It also reduces the duration of ICU and Hospital stay. We therefore recommend that early and immediate extubation be used more frequently in cardiac surgeries.