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J Cardiothorac Vasc Anesth. 2019 Sep;33(9):2465-2470. doi: 10.1053/j.jvca.2019.01.064. Epub 2019 Feb 8.

Thirty-Day Unplanned Reintubation Following Pleurodesis: A Retrospective National Registry Analysis.

Author information

1
School of Medicine, University of California San Diego, La Jolla, CA. Electronic address: bnburton@ucsd.edu.
2
School of Medicine, University of California San Diego, La Jolla, CA.
3
College of Medicine, University of Illinois, Chicago, IL.
4
Department of Anesthesiology, University of California San Diego, La Jolla, CA; Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, CA.
5
Department of Anesthesiology, University of California San Diego, La Jolla, CA.

Abstract

OBJECTIVE:

To examine risk factors associated with 30-day unplanned reintubation after pleurodesis.

DESIGN:

A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program surgical outcomes registry.

SETTING:

United States hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program.

PARTICIPANTS:

The study comprised 2,358 patients who underwent video-assisted thorascopic surgery for pleurodesis from 2007 to 2016.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The final sample included 2,358 cases, of which 93 (3.9%) required 30-day unplanned reintubation. Cases with 30-day unplanned reintubation, compared to those without, had higher unadjusted rates of American Society of Anesthesiologists physical status (ASA PS) score ≥4 (54.8% v 27.2%), preoperative dyspnea (71% v 57%), congestive heart failure (14% v 5.4%), functional dependence (28% v 10.3%), and diabetes mellitus (29% v 17.8%) (all p < 0.05). Patients with 30-day reintubation experienced higher unadjusted rates of 30-day outcomes including mortality (50.5% v 10.1%), pneumonia (28% v 4.9%), ventilator dependence (50.5% v 10.1%), sepsis (7.5% v 1.9%), myocardial infarction (5.4% v 0.1%), cardiac arrest (18.3% v 0.6%), transfusion (14% v 4.5%), and reoperation (15.1% v 3.2%) (all p < 0.05). The odds of 30-day unplanned reintubation were increased significantly on multivariable analysis for patients with ASA PS score ≥4, functional dependence, disseminated cancer, renal dialysis, and weight loss (all p < 0.05).

CONCLUSION:

Given the dearth of population-based studies addressing risk factors of reintubation after pleurodesis, this study suggests further review of preoperative optimization, which is required to improve patient outcomes and safety.

KEYWORDS:

ACS NSQIP; pleurodesis; reintubation

PMID:
30852091
DOI:
10.1053/j.jvca.2019.01.064

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