Journal of cardiothoracic and vascular anesthesia · 2026
Operating Room Extubation in Major Aortic Surgery: Policy Change Leading to Improved Recovery.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Magouliotis Dimitrios E, Sicouri Serge, Baudo Massimo, Yamashita Yoshiyuki, Patel Shalin, Herman Corey, Ahmad Bilal, Berguson Mark, Ramlawi Basel
Аннотация
OBJECTIVES: Enhanced recovery strategies in cardiac surgery emphasize early liberation from mechanical ventilation. Operating room (OR) extubation is one approach to improve outcomes and reduce resource utilization. This study evaluated a quality-improvement intervention (QII) designed to establish OR extubation as the default recovery pathway in open aortic surgery.
DESIGN: Retrospective, single-center cohort study with QII analyzed by pre- and post-implementation periods.
SETTING: Single academic medical center.
PARTICIPANTS: Adults undergoing open aortic surgery between 2014 and 2025 (N = 658), analyzed by extubation pathway (OR v intensive care unit [ICU]) and intervention period.
INTERVENTIONS: A multidisciplinary QII was implemented in 2020 using plan-do-study-act cycles, impact-confidence-ease prioritization, and the Kotter change-management framework to systematically adopt OR extubation as institutional standard practice.
MEASUREMENTS AND MAIN RESULTS: The primary endpoint was prolonged ICU length of stay (LOS), defined as ICU LOS exceeding the 75th percentile (>124 hours); a sensitivity analysis used ICU LOS >72 hours. Safety outcomes included major complications and mortality. Among 658 patients, 191 (29%) were extubated in the OR and 467 (71%) were extubated in the ICU. Prolonged ICU stay (>124 hours) occurred in 8% of OR-extubated patients versus 35% of ICU-extubated patients (p < 0.001). According to the >72-hour definition, prolonged ICU stay occurred in 35% of OR-extubated patients versus 71% of ICU-extubated patients (p < 0.001). Following QII implementation, OR extubation rates increased from <5% to >50% of cases, while rates of prolonged ICU stay declined from 33% to 19% (p < 0.001) and median ICU LOS decreased from 96 to 65 hours (p < 0.001). There were no differences in mortality or major complications.
CONCLUSIONS: OR extubation was associated with reduced prolonged ICU utilization after open aortic surgery without compromising safety. When implemented through a structured quality-improvement framework, OR extubation achieves durable system-level adoption and offers a scalable strategy to improve recovery and ICU capacity.
DESIGN: Retrospective, single-center cohort study with QII analyzed by pre- and post-implementation periods.
SETTING: Single academic medical center.
PARTICIPANTS: Adults undergoing open aortic surgery between 2014 and 2025 (N = 658), analyzed by extubation pathway (OR v intensive care unit [ICU]) and intervention period.
INTERVENTIONS: A multidisciplinary QII was implemented in 2020 using plan-do-study-act cycles, impact-confidence-ease prioritization, and the Kotter change-management framework to systematically adopt OR extubation as institutional standard practice.
MEASUREMENTS AND MAIN RESULTS: The primary endpoint was prolonged ICU length of stay (LOS), defined as ICU LOS exceeding the 75th percentile (>124 hours); a sensitivity analysis used ICU LOS >72 hours. Safety outcomes included major complications and mortality. Among 658 patients, 191 (29%) were extubated in the OR and 467 (71%) were extubated in the ICU. Prolonged ICU stay (>124 hours) occurred in 8% of OR-extubated patients versus 35% of ICU-extubated patients (p < 0.001). According to the >72-hour definition, prolonged ICU stay occurred in 35% of OR-extubated patients versus 71% of ICU-extubated patients (p < 0.001). Following QII implementation, OR extubation rates increased from <5% to >50% of cases, while rates of prolonged ICU stay declined from 33% to 19% (p < 0.001) and median ICU LOS decreased from 96 to 65 hours (p < 0.001). There were no differences in mortality or major complications.
CONCLUSIONS: OR extubation was associated with reduced prolonged ICU utilization after open aortic surgery without compromising safety. When implemented through a structured quality-improvement framework, OR extubation achieves durable system-level adoption and offers a scalable strategy to improve recovery and ICU capacity.