Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2026.844761
Brazilian Journal of Anesthesiology
Original Investigation

Clinical impact of extubation in the operating room after cardiac surgery: a retrospective analysis of a prospective registry

Impacto clínico da extubação em centro cirúrgico após cirurgia cardíaca: uma análise retrospectiva de um registro prospectivo

Patricia Silva de Marco, Pedro Henrique Romani Lauand, Luiz Carlos Volpi Júnior, Raphael Fernandes Cardoso Vianna Alves, Maria Paula Belini, Lilia Nigro Maia, Maurício Nassau Machado, Marcelo Arruda Nakazone

http://dx.doi.org/10.1016/j.bjane.2026.844761 Braz J Anesthesiol, vol.76, n4, 844761, 2026
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Abstract

Background

The practice of immediate extubation in the Operating Room (OR) after cardiac surgery involving cardiopulmonary bypass remains debated. Concerns persist regarding its safety profile compared to conventional fast-track weaning in the Intensive Care Unit (ICU).

Methods

This retrospective analysis of a prospective single-center registry included 846 adult patients undergoing isolated Coronary Artery Bypass Grafting (CABG) or Heart Valve Surgery (HVS). To rigorously account for indication bias, we employed a doubly robust estimation approach, combining Stabilized Inverse Probability of Treatment Weighting (SIPTW) with multivariable regression adjustment for residual confounding.

Results

Of the 846 patients, 115 (13.6%) were extubated in the OR and 731 (86.4%) in the ICU. The weighted analysis successfully balanced baseline characteristics. Extubation in the OR was associated with a significant reduction in 30-day mortality (adjusted Hazard Ratio [aHR = 0.16]; 95% CI 0.03–0.92; p = 0.040) and acute kidney injury (adjusted Odds Ratio [aOR = 0.55]; 95% CI 0.31–0.99; p = 0.046). Additionally, it reduced the likelihood of prolonged ICU stay (> 14 days) (aOR = 0.10; p = 0.032). Contrary to unadjusted analyses, there was no significant association with respiratory tract infection (p = 0.163), reintubation (p = 0.103), or other adverse events.

Conclusion

In this single-center, robustly adjusted analysis, extubation in the OR was associated with favorable outcomes, including lower 30-day mortality and reduced resource utilization in highly selected patients. Previous concerns regarding increased reintubation rates were not substantiated.

Keywords

Acute kidney injury; Airway extubation; Cardiac surgical procedures; Coronary artery bypass; Mortality; Propensity score  

Resumo

Introdução

A prática de extubação imediata em centro cirúrgico após cirurgia cardíaca envolvendo circulação extracorpórea permanece em debate. Persistem preocupações quanto ao seu perfil de segurança em comparação ao desmame convencional em regime de fast-track na Unidade de Terapia Intensiva (UTI).

Métodos

Esta análise retrospectiva de um registro prospectivo de centro único incluiu 846 pacientes adultos submetidos à cirurgia de revascularização do miocárdio isolada ou cirurgia valvular cardíaca. Para lidar rigorosamente com o viés de indicação, empregou-se uma abordagem de estimativa duplamente robusta, combinando a Ponderação de Probabilidade Inversa de Tratamento Estabilizada (SIPTW) com ajuste de regressão multivariável para confusão residual.

Resultados

Dos 846 pacientes, 115 (13,6%) foram extubados em centro cirúrgico e 731 (86,4%) na UTI. A análise ponderada equilibrou com sucesso as características basais. A extubação em centro cirúrgico foi associada a uma redução significativa na mortalidade em 30 dias (Razão de Riscos ajustada [aHR = 0,16]; IC 95% 0,03–0,92; p = 0,040) e lesão renal aguda (Razão de Chances ajustada [aOR = 0,55]; IC 95% 0,31–0,99; p = 0,046). Além disso, reduziu a probabilidade de permanência prolongada na UTI (> 14 dias) (aOR = 0,10; p = 0,032). Contrariamente às análises não ajustadas, não houve associação significativa com infecção do trato respiratório (p = 0,163), reintubação (p = 0,103) ou outros eventos adversos.

Conclusão

Nesta análise de centro único com ajuste robusto, a extubação em centro cirúrgico foi associada a desfechos favoráveis, incluindo menor mortalidade em 30 dias e redução na utilização de recursos em pacientes altamente selecionados. Preocupações anteriores sobre o aumento das taxas de reintubação não foram confirmadas.

Palavras-chave

Extubação; Procedimentos cirúrgicos cardíacos; Revascularização do miocárdio; Escore de propensão; Lesão renal aguda; Mortalidade

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Submitted date:
08/23/2025

Accepted date:
04/09/2026

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