Association of reintubation and hospital costs and its modification by postoperative surveillance: A multicenter retrospective cohort study

We estimated hospital costs associated with postoperative reintubation and tested the hypothesis that prolonged surveillance in the post-anesthesia care unit (PACU) modifies the hospital costs of reintubation. Retrospective observational research study. Two tertiary care academic healthcare networks in the Bronx, New York and Boston, Massachusetts, USA. 68,125 adult non-cardiac surgical patients undergoing general anesthesia between 2016 and 2021. The exposure variable was unplanned reintubation within 7 days of surgery. The primary outcome was direct hospital costs associated with patient care related activities. We used a multivariable generalized linear model based on log-transformed costs data, adjusting for pre- and intraoperative confounders. We matched our data with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS). In the key secondary analysis, we examined if prolonged postoperative surveillance, defined as PACU utilization (≥4 h) modifies the association between reintubation and costs of care. 1759 (2.6%) of patients were re-intubated within 7 days after surgery. Reintubation was associated with higher direct hospital costs (adjusted model estimate 2.05; 95% CI: 2.00–2.10) relative to no reintubation. In the HCUP-NIS matched cohort, the adjusted absolute difference (ADadj) in costs amounted to US$ 18,837 (95% CI: 17,921–19,777). The association was modified by the duration of PACU surveillance (p-for-interaction