Immediate Postoperative Extubation Decreases Pulmonary Complications in Liver Transplant Patients

Authors

Christine Acho, Henry Ford HealthFollow
Yoshihisa Morita, Henry Ford HealthFollow
Valeria Fernandez, Henry Ford HealthFollow
Mohamed Safwan, Henry Ford Health
Dragos Galusca, Henry Ford HealthFollow
Marwan S. Abouljoud, Henry Ford HealthFollow
Atsushi Yoshida, Henry Ford HealthFollow
Jaber El-Bashir, Henry Ford HealthFollow
Shunji Nagai, Henry Ford HealthFollow

Recommended Citation

Acho C, Morita Y, Fernandez V, Safwan M, Galusca D, Abouljoud M, Yoshida A, El-Bashir J, and Nagai S. Immediate Postoperative Extubation Decreases Pulmonary Complications in Liver Transplant Patients. Transplantation 2021; 105(9):2018-2028.

Document Type

Article

Publication Date

9-1-2021

Publication Title

Transplantation

Abstract

BACKGROUND: Fast-track anesthesia in liver transplantation (LT) has been discussed over the past few decades; however, factors associated with immediate extubation after LT surgery are not well defined. This study aimed to identify predictive factors and examine impacts of immediate extubation on post-LT outcomes.

METHODS: A total of 279 LT patients between January 2014 and May 2017 were included. Primary outcome was immediate extubation after LT. Other postoperative outcomes included reintubation, intensive care unit stay and cost, pulmonary complications within 90 days, and 90-day graft survival. Logistic regression was performed to identify factors that were predictive for immediate extubation. A matched control was used to study immediate extubation effect on the other postoperative outcomes.

RESULTS: Of these 279 patients, 80 (28.7%) underwent immediate extubation. Patients with anhepatic time >75 minutes and with total intraoperative blood transfusion ≥12 units were less likely to be immediately extubated (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.89; P = 0.02; OR, 0.11; 95% CI, 0.05-0.21; P < 0.001). The multivariable analysis showed immediate extubation significantly decreased the risk of pulmonary complications (OR, 0.34; 95% CI, 0.15-0.77; P = 0.01). According to a matched case-control model (immediate group [n = 72], delayed group [n = 72]), the immediate group had a significantly lower rate of pulmonary complications (11.1% versus 27.8%; P = 0.012). Intensive care unit stay and cost were relatively lower in the immediate group (2 versus 3 d; P = 0.082; $5700 versus $7710; P = 0.11). Reintubation rates (2.8% versus 2.8%; P > 0.9) and 90-day graft survival rates (95.8% versus 98.6%; P = 0.31) were similar.

CONCLUSIONS: Immediate extubation post-LT in appropriate patients is safe and may improve patient outcomes and resource allocation.

Medical Subject Headings

Transplant and Abdominal Surgery

PubMed ID

32890127

Volume

105

Issue

9

First Page

2018

Last Page

2028