Key result
Early extubation within 4 hours of meeting criteria after acute high-risk abdominal surgery was independently associated with a shorter hospital stay (BETA -2.075 days) compared to delayed extubation.
Why the study?
It was unclear whether early extubation practices affect patient outcomes after acute high-risk abdominal surgery.
Does early extubation reduce the length of hospital stay in patients undergoing acute high-risk abdominal surgery?
Cohort (n=1,074)
No
Does early extubation reduce the length of hospital stay in patients undergoing acute high-risk abdominal surgery?
Early extubation within 4 hours of meeting criteria after acute high-risk abdominal surgery is associated with reduced postoperative pulmonary infections and shorter hospital stays.
Early extubation was associated with shorter stays after acute high-risk abdominal surgery; hypothesis-generating for randomized confirmation.
It is unclear whether Early Extubation (EE) practices affect the patient outcomes after Acute High-risk Abdominal (AHA) surgery. This study aims to explore the impact of EE on the postoperative prognosis of AHA surgery patients. A screening and analysis were performed among 9219 patients who underwent AHA surgery from January 2012 to December 2019. After meeting the pre-determined extubation criteria, patients were divided into two groups: EE (≤ 4 h) and Delayed Extubation (DE) (< 4 h) according to the time of extubation. Various clinical indicators were compared between the EE and DE groups after propensity-score matching. Hospital stay was the primary outcome assessed. And multivariate and subgroup analyses were performed to identify independent predictors of hospital stay length. After propensity-score matching, a total of 1074 patients were enrolled, including 537 in the EE group and 537 in the DE group. A greater number of DE patients underwent laparotomy and used vasoactive drugs than EE patients (p < 0.001). Compared to the DE group, the EE group had significantly shorter intubation time (285 [IQR 225, 350] vs. 427[IQR 300, 514]), lower postoperative pulmonary infection rates, and considerably shorter hospital stay (12 [IQR 10, 16] vs. 14 [IQR 10, 19]) (p < 0.001). In stepwise multivariable analysis, EE status (BETA-2.075; 95%CI (-2.898, -1.217)) and postoperative pulmonary infection (BETA 0.401; 95%CI (-2.898, -1.217)) were identified as independent variables associated with a longer hospital stay. Furthermore, EE status were identified as independent variables associated with a longer hospital stay, in subgroups (various diagnosis, BMI and sex) analysis. Extubation within 4 h of meeting extubation criteria in AHA surgery was associated with improved postoperative outcomes, including reduced postoperative pulmonary infection, and a shorter hospital stay. However, prospective randomized controlled trials are needed to confirm the observed benefits and establish optimal timing for extubation.
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Li et al. (2025) conducted a cohort in Acute High-risk Abdominal (AHA) surgery (n=1,074). Early extubation (≤ 4 hours) vs. Delayed extubation (> 4 hours) was evaluated on Length of hospital stay (BETA -2.075, 95% CI -2.898, -1.217, p=<0.001). Early extubation within 4 hours of meeting criteria after acute high-risk abdominal surgery was independently associated with a shorter hospital stay (BETA -2.075 days) compared to delayed extubation.
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