Incidence, Risk Factors, and Clinical Outcomes of Postoperative Reintubation after Planned Extubation in Adults Undergoing General Anesthesia: A Single-center Experience:

Phonneeya  Nimpunyakampong; Manatsanan  Denthet; Aphichat  Suphathamwit; Wariya  Vongchaiudomchoke

doi:10.33192/smj.v77i10.274468

Authors

Phonneeya Nimpunyakampong Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Department of Anesthesiology, Burirum Hospital, Burirum, Thailand.
Manatsanan Denthet Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Aphichat Suphathamwit Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Wariya Vongchaiudomchoke Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v77i10.274468

Keywords:

Anesthesia complication, extubation, mortality, postoperative complication, postoperative reintubation, risk factors

Abstract

Objective: Postoperative reintubation after planned extubation (PRAP) is a complication following general anesthesia. This study aimed to determine the incidence, risk factors, and outcomes in a tertiary-care university hospital.

Materials and Methods: A retrospective case-control study was conducted between 2014 and 2022. The PRAP group included patients requiring reintubation within 2 h after planned extubation following general anesthesia, while the control group included patients who did not require reintubation. Cases and controls were matched in a 1:3 ratio, with time-matched controls randomly selected within 2 weeks. Descriptive statistics and logistic regression
were utilized for analysis.

Results: Of 139,103 patients, 88 PRAP cases were identified, yielding an incidence of 0.06% (95% Confidence Interval [CI], 0.05–0.08). Multivariate analysis revealed independent risk factors associated with PRAP: the American Society of Anesthesiologists Physical Status (ASA) ≥ III (adjusted odds ratio [aOR], 2.72; 95% CI, 1.58–4.66; P < 0.001), hemoglobin < 12 g/dL (aOR, 1.76; 95% CI, 1.02–3.01; P = 0.041), creatinine clearance < 60 mL/min (aOR, 3.38; 95% CI, 2.16–5.30; P < 0.001), and chronic obstructive pulmonary disease (COPD) (aOR, 18.73; 95% CI, 1.60–219.22; P = 0.020). PRAP was associated with increased 30-day mortality, cardiac arrest, and prolonged length of hospital and intensive care unit stay (all, P < 0.001).

Conclusion: The incidence of PRAP was 0.06%. Independent risk factors associated with PRAP were ASA, hemoglobin, creatinine clearance, and COPD. PRAP is associated with adverse postoperative outcomes, highlighting the need for preventive strategies and careful perioperative management.

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