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This study evaluated the occurrence of reintubation after planned extubation (RAP), the impact of RAP on duration of PACU stay,length of stay,length of postoperative stay,inpatient healthcare costs, unanticipated ICU admission and readmission.
The study was carried out in Wuhan City, China at a general public university hospital with 62 clinical departments, 99 surgical rooms, and 38 beds in the PACU. The total number of operations performed in this hospital is more than 90,000/year. The study was approved by the hospital ethics committee and was deemed that written patient consent was not required. The adverse events, including RAP, in all patients in the PACU were recorded on a standardized form in a database by pre-trained qualified nurses and/or anesthesiologists at the time of care from January 1, 2017 to December 31, 2019.
Data, including patient demographic and surgical and anesthesia parameters, were obtained from the anesthesia information system. Adverse events management and duration of PACU stay were also documented. For three years, all collected data were filed in a computer every day and were summarized and analyzed every month. Data, such as demographics, airway, oxygen saturation, consciousness, treatment, vital signs, and fast-track criteria scores, were recorded for all patients in the PACU. The first part contained preoperative and intraoperative data, which were entered into the database by the anesthesiologists involved in the patients' intraoperative care from the time of PACU admission. The second part were recorded by nurse and comprised postoperative data from the PACU to the ward or ICU. The third part were recorded by the surgeons and/ or surgical nurses and comprised postoperative data. The criteria for tracheal extubation in the operating room(OR) and the timing of transfer to the PACU were the responsibility of the anesthesiologist.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Reintubation after planned extubation | Reintubation after planned extubation(RAP) was defined as repeat endotracheal intubation in the PACU after planned extubation of the initial endotracheal intubation for general anesthesia or combined general anesthesia other than that performed in the operating room. |
| |
| matched group | Patients without RAP during the PACU stay were designated as the matched group |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| repeat endotracheal intubation | Procedure | repeat endotracheal intubation in the PACU after planned extubation of the initial endotracheal intubation for general anesthesia or combined general anesthesia other than that performed in the operating room |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of PACU stay | From patient transfer into PACU to transfer out of PACU | through study completion, an average of three months |
| Length of postoperative stay | through study completion, an average of three months | |
| Unanticipated ICU admission | Unplanned transfer to the ICU | through study completion, an average of three months |
| Measure | Description | Time Frame |
|---|---|---|
| Inpatient healthcare costs | Any medical cost during hospital stay | through study completion, an average of three months |
| Length of stay | The time of hospital length of stay |
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Inclusion Criteria:
Exclusion Criteria:
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Reintubation after planned extubation was defined as repeat endotracheal intubation in the PACU after planned extubation of the initial endotracheal intubation for general anesthesia or combined general anesthesia other than that performed in the operating room.
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| Name | Affiliation | Role |
|---|---|---|
| Hui Xu | Tongji Hospital | Study Chair |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11873052 | Background | American Society of Anesthesiologists Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: a report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2002 Mar;96(3):742-52. doi: 10.1097/00000542-200203000-00033. No abstract available. | |
| 16600829 | Background |
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Reintubation after planned extubation (RAP) is a serious adverse event. This study aimed to determine the rate and impact of RAP on postoperative course and hospitalization outcomes
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| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| through study completion, an average of three months |
| Duration of postoperative monitoring | The time of postoperative monitoring | through study completion, an average of three months |
| Readmission | admission after hospital discharge | through study completion, an average of three months |
| Tarrac SE. A description of intraoperative and postanesthesia complication rates. J Perianesth Nurs. 2006 Apr;21(2):88-96. doi: 10.1016/j.jopan.2006.01.006. |
| 24095886 | Background | Siddiqui N, Arzola C, Teresi J, Fox G, Guerina L, Friedman Z. Predictors of desaturation in the postoperative anesthesia care unit: an observational study. J Clin Anesth. 2013 Dec;25(8):612-7. doi: 10.1016/j.jclinane.2013.04.018. Epub 2013 Oct 4. |
| 22777658 | Background | Rujirojindakul P, Geater AF, McNeil EB, Vasinanukorn P, Prathep S, Asim W, Naklongdee J. Risk factors for reintubation in the post-anaesthetic care unit: a case-control study. Br J Anaesth. 2012 Oct;109(4):636-42. doi: 10.1093/bja/aes226. Epub 2012 Jul 9. |
| 31587745 | Background | Haritos G, Smith CA, Haas RE, Becker A, Nguyen D, Stierer KA, Klein M. Critical Events Leading to Endotracheal Reintubation in the Postanesthesia Care Unit: A Retrospective Inquiry of Contributory Factors. AANA J. 2019 Feb;87(1):59-63. |
| 14724078 | Background | Lee PJ, MacLennan A, Naughton NN, O'Reilly M. An analysis of reintubations from a quality assurance database of 152,000 cases. J Clin Anesth. 2003 Dec;15(8):575-81. doi: 10.1016/j.jclinane.2003.03.006. |
| 27439784 | Background | Bruins SD, Leong PM, Ng SY. Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital. Singapore Med J. 2017 Aug;58(8):497-501. doi: 10.11622/smedj.2016126. Epub 2016 Jul 21. |
| 21195986 | Background | Ting PC, Chou AH, Yang MW, Ho AC, Chang CJ, Chang SC. Postoperative reintubation after planned extubation: a review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan. Acta Anaesthesiol Taiwan. 2010 Dec;48(4):167-71. doi: 10.1016/j.aat.2010.12.003. Epub 2010 Dec 22. |
| Background | Siao-feng A, Tai-di Z, OU QH. Risk factors for postoperative reintubation in patients undergoing general anesthesia. Chin J Anesthesiol. 2013;33(12):1427-30. |
| 27595531 | Background | Beverly A, Brovman EY, Malapero RJ, Lekowski RW, Urman RD. Unplanned Reintubation Following Cardiac Surgery: Incidence, Timing, Risk Factors, and Outcomes. J Cardiothorac Vasc Anesth. 2016 Dec;30(6):1523-1529. doi: 10.1053/j.jvca.2016.05.033. Epub 2016 May 21. |
| 22324979 | Background | Menon N, Joffe AM, Deem S, Yanez ND, Grabinsky A, Dagal AH, Daniel S, Treggiari MM. Occurrence and complications of tracheal reintubation in critically ill adults. Respir Care. 2012 Oct;57(10):1555-63. doi: 10.4187/respcare.01617. Epub 2012 Feb 10. |
| 22817271 | Background | Ing C, Chui I, Ohkawa S, Kakavouli A, Sun L. Incidence and causes of perioperative endotracheal reintubation in children: a review of 28,208 anesthetics. Paediatr Anaesth. 2013 Jul;23(7):621-6. doi: 10.1111/j.1460-9592.2012.03920.x. Epub 2012 Jul 23. |
| 27352366 | Background | De la Garza Ramos R, Passias PG, Schwab F, Bydon A, Lafage V, Sciubba DM. Incidence, Risk Factors, and Mortality of Reintubation in Adult Spinal Deformity Surgery. Clin Spine Surg. 2017 Aug;30(7):E896-E900. doi: 10.1097/BSD.0000000000000404. |
| 27377334 | Background | Gao F, Yang LH, He HR, Ma XC, Lu J, Zhai YJ, Guo LT, Wang X, Zheng J. The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis. Heart Lung. 2016 Jul-Aug;45(4):363-71. doi: 10.1016/j.hrtlng.2016.04.006. |
| 31016529 | Result | Liu SK, Chen G, Yan B, Huang J, Xu H. Adverse Respiratory Events Increase Post-anesthesia Care Unit Stay in China: A 2-year Retrospective Matched Cohort Study. Curr Med Sci. 2019 Apr;39(2):325-329. doi: 10.1007/s11596-019-2038-y. Epub 2019 Apr 23. |