Cost-effectiveness and predictors of early extubation

This study examined predictors and cost-effectiveness of early extubation after coronary artery bypass grafting. Six hundred forty-five patients admitted to intensive care units after coronary artery bypass grafting at our institutions in 1993 were reviewed. There were 455 male and 190 female patients, which included all patients in DRG 106 and DRG 107. The patients were categorized into three groups: group A (269 patients) were extubated in less than 12 hours (7.55 ± 2.5 hours), group B (291 patients) were extubated between 12 and 24 hours (16.85 ± 3.3 hours), and group C (376 patients) were extubated any time after 12 hours. The reintubation rate for the entire group was less than 1%. Univariate preoperative analyses revealed small differences between groups A and B: only 6 of 25 variables were found to reach statistical significance. Stepwise logistic regression analyses were carried out in 269 patients of group A and 376 patients of group C. Older patients (log of age, p = 0.0001), female sex ( p = 0.0129; odds ratio = 1.634), use of preoperative diuretics ( p = 0.0010; odds ratio = 1.965) and unstable angina ( p = 0.0301; odds ratio = 1.544) were noted to be clinical factors associated with late extubation (≥12 hours). Early extubation was accomplished in 42%; however, further analysis revealed that many patients who were intubated overnight should have been extubated sooner. Early extubation shortened the postoperative length of stay, resulting in reduction of cost and resource utilization. The average hospital charge per patient was approximately $6,000 less in the early extubation group.