Key result
RACHS-1 category 4 linked to ~43% higher risk of failing operating room extubation.
Why the study?
The incidence, success rate, and factors associated with non-extubation and extubation failure for intentional operating room extubation after elective congenital cardiac surgery at a Brazilian federal referral center needed investigation.
What is the incidence and success rate of intentional operating room extubation, and what factors are associated with non-extubation and extubation failure in pediatric patients undergoing elective congenital cardiac surgery?
Cohort (n=637)
No
What is the incidence and success rate of intentional operating room extubation, and what factors are associated with non-extubation and extubation failure in pediatric patients undergoing elective congenital cardiac surgery?
Intentional operating room extubation after elective pediatric congenital cardiac surgery is feasible and safe in selected patients at a public referral center, achieving a 37% incidence and 98% success rate.
Answers are grounded in this paper and cite their sources.
Supports selective operating room extubation in lower-risk pediatric cases; extends observational data but leaves open need for prospective validation.
Objective: To investigate the incidence and success of intentional postoperative operating room extubation after elective congenital cardiac surgery at a Brazilian federal referral center and identify factors associated with non-extubation and extubation failure. Methods: This historical cohort study was conducted in a pediatric and neonatal cardiac intensive care unit over five years. Patients aged 0–18 years with congenital heart disease who underwent elective corrective or palliative cardiac surgery without preoperative mechanical ventilation were included. The primary outcome was operating room extubation, and the secondary outcome was extubation success, defined as no reintubation within 48 postoperative hours. Multivariable Poisson regression with robust variance identified factors independently associated with nonextubation and extubation failure (p<0.05). Results: Among 637 patients, 37% were extubated in the operating room, with a 98% success rate. They were older, had higher body weight, shorter noninvasive ventilation duration, shorter intensive care unit stays, and lower mortality. Increasing age reduced the risk of non-extubation. The need for noninvasive ventilation and longer intensive care unit stay were independently associated with non-extubation and extubation failure, although only four failures occurred. Conclusions: Operating room extubation was feasible in a substantial proportion of pediatric patients and achieved a high success rate, supporting its safety in selected cases. Greater surgical complexity, need for noninvasive ventilation, and longer intensive care unit stay increased the risk of non-extubation, whereas increasing age reduced this risk.
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Vieira et al. (2026) conducted a cohort in Congenital heart disease undergoing elective corrective or palliative cardiac surgery (n=637). Intentional postoperative operating room extubation vs. No operating room extubation (remaining intubated postoperatively) was evaluated on Operating room extubation (and multivariable factors associated with non-extubation in the operating room, such as RACHS-1 Category 4) (RR 1.43, 95% CI 1.07–1.89, p=0.014). Operating room extubation was achieved in 37% of pediatric cardiac surgery patients with a 98% success rate, while RACHS-1 category 4 increased non-extubation risk.
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