Immediate postoperative extubation in cardiac surgery patients, a propensity score matching analysis

Abstract Introduction Ultra-Fast-Track or ERAS (enhanced recovery after surgery) concepts are emerging for cardiac surgery patients due to potential benefits. However, the optimal timing of extubation in patients undergoing cardiopulmonary bypass surgery remains a subject of ongoing debate. Since 2021, we have implemented Ultra-Fast-Track concepts in our clinic, with immediate postoperative extubation in the operating room (OR) as a key component. Purpose This study aimed to evaluate the effects of immediate postoperative extubation in cardiac surgery patients. Specifically, it sought to determine the impact of early extubation on postoperative complications, blood product utilization, intensive care unit (ICU) length of stay, and overall hospital stay. By employing Propensity Score Matching (PSM), we aimed to reduce confounding factors and provide robust evidence. Methods We conducted a retrospective, single-center study including patients who underwent cardiac surgery with cardiopulmonary bypass between January 2021 and July 2024. Statistical analyses were performed using RStudio. PSM was based on age, gender, ASA classification, preoperative LV function, type of surgery (aortic surgery, valve surgery, bypass surgery, combined procedures), and postoperative circulatory status (low- or high-dose catecholamines). Outcome parameters analyzed post-PSM included delirium, re-thoracotomy, administered blood products, ICU stay and total hospital stay. Results A total of 3,681 patients were included, with 246 (6.68 %) extubated immediately after surgery. After PSM, the final analysis included 454 patients, of whom 227 were extubated in the OR. Patients extubated immediately received fewer blood products: significantly fewer units of packed red blood cells (0.64 vs. 1.18 U, p = 0.003) and fresh frozen plasma (0.07 vs. 0.59 U, p < 0.001) were administered. The use of platelet concentrates, fibrinogen and PPSB was lower, but not statistically significant. Moreover, immediate postoperative extubation led to a significantly shorter ICU stay (1.37 vs. 1.89 days, p < 0.001), though the total hospital stay remained similar between groups (10.15 vs. 10.59 days, p = 0.65). The rate of postoperative delirium (8.8 % vs. 18.1 %) and re-thoracotomy (2.2 % vs. 4.4 %) was lower in immediately extubated patients, though not statistically significant (p = 0.099 and p = 0.056, respectively). Conclusion Immediate postoperative extubation in cardiac surgery is safe and feasible. It is associated with fewer blood product requirements and shorter ICU stays. These results suggest early extubation may enhance patient outcomes and optimize resource utilization, particularly in ICU capacity management and blood product consumption. Future studies are needed to evaluate long-term impact of early extubation on recovery and healthcare costs.