T. M. Bauer1, A. P. Johnson1, S. W. Cowan1, R. R. Kelz2 1Thomas Jefferson University,Thoracic Surgery,Philadelphia, PA, USA 2University Of Pennsylvania,Endocrine And Oncologic Surgery,Philadelphia, PA, USA
Introduction: Persistent anesthetic or medication complications represent a common cause for postoperative respiratory failure in the immediate postoperative period. New medications are available to more rapidly reverse deep paralysis. This study aimed to characterize patients at highest risk for unplanned intubation (UI) in the immediate post-operative period due to persistent anesthetic as a target population for new medication trials, or increased pulmonary monitoring in the immediate post-operative period.
Methods: We queried the 2014 ACS NSQIP Participant Use File (PUF) for all patients who experienced post-operative day (POD) 0 UI for all procedures without concurrent postoperative complications, such as cardiac arrest, sepsis, septic shock, myocardial infarction, cerebrovascular accident, and coma. Univariable and multivariable logistic regression analyses were used to identify patient and operative characteristics associated with UI in the immediate post-operative period.
Results: Among 706,791 patients, 702 (0.1%) of experienced isolated POD 0 UI. Multivariable logistic regression analysis identified 14 patient factors and 6 operation types significantly associated with an elevated likelihood of POD 0 UI (p= <.05). The eight patient factors most strongly associated with POD 0 UI included ASA class >= 3, general anesthesia, preoperative transfusion (<72 hrs), age > 60 years, dyspnea on exertion and at rest, severe COPD, hypertension requiring medications, and operative time > 3 hours (p<0.001). After controlling for patient factors, the 6 procedures significantly associated with a higher likelihood of POD 0 UI (p<0.05) were esophagectomy (OR: 3.6), EVAR (OR: 2.66), open aortoilliac revascularization (OR: 2.43), nephrectomy (OR: 1.97), hip fracture (OR: 1.81) and colectomy (OR: 1.43). Three procedures were associated with significantly lower likelihood of POD 0 UI (p<0.05): TURP (OR: 0.12), total knee arthroplasty (OR: 0.47) and spine (OR: 0.57).
Conclusion: We have identified 14 independent patient factors and 6 procedures strongly associated with higher likelihoods of isolated POD 0 unplanned reintubation. Combining these risk factors with clinical indications for ineffective reversal of anesthesia can help effectively target the use of new anesthesia reversal drugs or increased pulmonary monitoring in the immediate post-operative period.