Factors associated with and consequences of unplanned post-operative intubation in elderly vascular and general surgery patients
- 1 March 2011
- journal article
- perioperative complications
- Published by Ovid Technologies (Wolters Kluwer Health) in European Journal of Anaesthesiology
- Vol. 28 (3), 220-224
- https://doi.org/10.1097/eja.0b013e328342659c
Abstract
Objective Unplanned post-operative intubation (UPI) may be associated with significant morbidity and/or mortality after surgery. The purpose of this investigation was to determine the incidence and predictors of UPI in elderly patients who underwent general and vascular surgical procedures. Methods Data from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File was used to calculate the incidence of UPI in all elderly vascular and general surgery patients undergoing operations from 2005 to 2008. UPI was defined as a requirement for the placement of an endotracheal tube and mechanical or assisted ventilation because of the onset of respiratory or cardiac failure manifested by severe respiratory distress, hypoxia, hypercarbia or respiratory acidosis within 30 days of the index operation. Univariate factors associated with UPI were identified. Multivariate stepwise logistic regression was used to calculate odds ratios (ORs) for UPI after controlling for known clinically relevant cofactors. Main outcome measures Incidence of UPI as well as morbidity and mortality associated with UPI. Results Among 115 692 patients, 3.3% required UPI. Univariate predictors of UPI were older age group, chronic obstructive pulmonary disease, low pre-operative functional status as well as emergency operation. UPI was associated with an 18-fold increased risk of death as well as significantly increased hospital length of stay. Multivariate analysis identified several predictors of UPI with re-operation having the greatest odds for UPI (OR = 4.5; 95% confidence interval = 4.29–4.86, P < 0.001). Conclusion Although the incidence of UPI in this elderly surgical cohort was low, it was associated with significant morbidity and mortality as well as prolonged hospital length of stay, underscoring the need for accurately identifying modifiable risk factors.Keywords
This publication has 13 references indexed in Scilit:
- The Patient Safety in Surgery Study: Background, Study Design, and Patient PopulationsJournal of the American College of Surgeons, 2007
- Risk factors for and economic implications of prolonged ventilation after cardiac surgeryThe Journal of Thoracic and Cardiovascular Surgery, 2005
- The outcome of extubation failure in a community hospital intensive care unit: a cohort studyCritical Care, 2004
- Assessment and management of the geriatric patientCritical Care Medicine, 2004
- Extubation failure: an outcome to be avoided.Critical Care, 2004
- Frailty in the elderly: contributions of sarcopenia and visceral protein depletionMetabolism, 2003
- Reintubation as an Outcome Predictor in Trauma PatientsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1996
- Effect of anaemia and cardiovascular disease on surgical mortality and morbidityThe Lancet, 1996
- Unplanned ExtubationSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1994
- Acute Complications of Endotracheal IntubationSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1986