The Association Between Extubation Time and Perioperative Outcomes in Valve Surgery Patients: A Retrospective Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Valvular heart disease undergoing elective cardiac valve repair (valvuloplasty) (n=127). Intervention: Late extubation (>6 hours postoperatively) vs. Early extubation (≤6 hours postoperatively). Primary outcome: Vasoactive-inotropic score indexed to ICU hours (VISmean) (Geometric mean ratio +35.3%, 95% CI +13.4% to +61.5%, p=0.0009).

Q: What does this research mean for the field?

Late extubation (>6 hours) following valve repair surgery is independently associated with higher vasoactive support requirements and longer ICU stays. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ding Zhang; Qing Peng; Yuan Huang; Song Jian; Xiaoxiao Sun; jian li; yinggang zheng; zongping fang

doi:10.21203/rs.3.rs-10720214/v1

September 30, 2026Open Access

The Association Between Extubation Time and Perioperative Outcomes in Valve Surgery Patients: A Retrospective Study

View Full Paper

Ask AI

Bookmark

Share

Key result

Late extubation after valve repair is linked to ~35% higher vasoactive-inotropic scores.

Geometric mean ratio +35.3%
95% CI +13.4% to +61.5%
P=0.0009
n=127

Why the study?

The timing of tracheal tube removal after valve repair may shape postoperative recovery, as late extubation has been tied to heavier vasoactive support and longer intensive care. This study examined whether extubation timing tracks with perioperative outcomes in valve repair patients.

Does late extubation (>6 hours) compared to early extubation (≤6 hours) track with higher vasoactive support requirements and longer ICU stay in adult patients undergoing elective cardiac valve repair?

Key Points

To examine whether the timing of tracheal extubation is associated with perioperative outcomes, particularly vasoactive support and intensive care duration, in patients undergoing valve repair surgery.
Single-center retrospective review of 127 patients undergoing valve repair surgery between March 2023 and May 2025.
Patients were divided by extubation timing into early (≤ 6 h, n=45) and late (> 6 h, n=82) groups.
Vasoactive support was measured as vasoactive-inotropic score indexed to ICU hours (VISmean), with multivariable linear regression on log-transformed outcomes adjusting for age, sex, heart failure, mitral regurgitation, and NYHA class.
After adjustment, late extubation was significantly associated with higher VISmean (geometric mean ratio +35.3%, 95% CI +13.4% to +61.5%, P = 0.0009).
Late extubation was associated with longer ICU stay (+28.6%, 95% CI +6.0% to +56.2%, P = 0.011) and longer operation time (+8.7%, 95% CI +2.1% to +15.8%, P = 0.010).
Median unadjusted VISmean was 3.24 [IQR 1.96–4.63] in the late group versus 2.22 [IQR 0.78–3.37] in the early group (P = 0.002), and median ICU stay was 93.79 h versus 72.00 h (P = 0.017).

Study Design

Type

Cohort (n=127)

Multicenter

No

Structured PICO

Does late extubation (>6 hours) compared to early extubation (≤6 hours) track with higher vasoactive support requirements and longer ICU stay in adult patients undergoing elective cardiac valve repair?

P

Population

127 adults (mean age 43.3 years, 71.7% female) undergoing elective cardiac valve repair at a single center in China, evaluated across the perioperative and ICU period.

E

Exposure

Late postoperative tracheal extubation (>6 hours after surgery, n=82)

C

Comparator

Early postoperative tracheal extubation (≤6 hours after surgery, n=45)

O

Outcome

Vasoactive-inotropic score indexed to ICU hours (VISmean)surrogate

Main Result

Effect estimate: Geometric mean ratio +35.3% (95% CI +13.4% to +61.5%)

Absolute Event Rate: 3.24% vs 2.22%

p-value: p=0.0009

In patients undergoing surgical cardiac valve repair, delayed extubation (>6 hours) is independently associated with higher time-averaged vasoactive-inotropic requirements and prolonged ICU stay, likely serving as a marker of underlying surgical complexity and illness severity.

Limitations

Retrospective, single-center design limiting causal inference and generalizability
Potential unmeasured confounding from postoperative monitoring protocols, anesthesia techniques, and overnight extubation holds
Small sample size underpowered to detect differences in rare complications such as pulmonary infection, pleural effusion, and reintubation
Use of time-averaged VISmean rather than peak VIS used in other studies
Retrospective and single-center design, limiting causal inference and generalizability
Potential confounding from unmeasured factors such as postoperative monitoring protocols and anesthesia techniques
Small sample size for rare complications, leaving the study underpowered to detect differences in pulmonary infection, pleural effusion, or reintubation
VISmean is a time-averaged measure and differs from the peak VIS used in other studies

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support early extubation protocols after valve repair; hypothesis-generating and requires prospective confirmation before practice change.

Abstract

Background For patients undergoing valve repair, how soon the tracheal tube is removed may shape postoperative recovery. Late extubation has been tied to heavier vasoactive support and longer intensive care. We examined whether extubation timing tracked with perioperative outcomes in 127 patients who had valve repair surgery. Methods This single-center retrospective review covered patients treated between March 2023 and May 2025, divided by extubation timing into early (≤ 6 h) and late (> 6 h) groups. Vasoactive support was quantified as the vasoactive-inotropic score indexed to ICU hours (VISmean). Group differences were tested with the Mann–Whitney U test or Fisher’s exact test, and multivariable linear regression on log-transformed outcomes adjusted for age, sex, heart failure, mitral regurgitation, and NYHA class. Results After adjustment, late extubation was associated with a higher VISmean (geometric mean ratio + 35.3%, 95% CI + 13.4% to + 61.5%, P = 0.0009), longer ICU stay (+ 28.6%, + 6.0% to + 56.2%, P = 0.011), and longer operation time (+ 8.7%, + 2.1% to + 15.8%, P = 0.010). No interaction with valve pathology reached significance. Conclusions Late extubation in valve repair patients is associated with heavier vasoactive support and longer ICU stay. These associations may reflect underlying disease severity more than the timing of extubation itself.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Zhang et al. (2026) conducted a cohort in Valvular heart disease undergoing elective cardiac valve repair (valvuloplasty) (n=127). Late extubation (>6 hours postoperatively) vs. Early extubation (≤6 hours postoperatively) was evaluated on Vasoactive-inotropic score indexed to ICU hours (VISmean) (Geometric mean ratio +35.3%, 95% CI +13.4% to +61.5%, p=0.0009). Late extubation (>6 h) after valve repair was associated with a 35.3% higher mean vasoactive-inotropic score and a 28.6% longer ICU stay compared to early extubation.

synapsesocial.com/papers/6ae28f53cbadf70daf6c44ea https://doi.org/10.21203/rs.3.rs-10720214/v1

View Full Paper

Ask AI

Bookmark

Share

The Association Between Extubation Time and Perioperative Outcomes in Valve Surgery Patients: A Retrospective Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Association Between Extubation Time and Perioperative Outcomes in Valve Surgery Patients: A Retrospective Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading