Abstract 13618: Day Time vs Night Time Extubation After Elective Tetralogy of Fallot Repair

Background: Daytime extubation post cardiac surgery has been associated with improved hospital outcome in adults. However, data in pediatrics are lacking. We hypothesized that daytime extubations are associated with shorter critical care time (CCT) and investigated the NIH/NHLBI Pediatric Heart Network Collaborative Learning Study (PHN CLS) open database with this goal. Methods: The PHN CLS was designed as a quality improvement project to implement early extubation guidelines in patients (pts) with Tetralogy of Fallot (ToF) and coarctation of the aorta across 10 centers. We included all ToF pts who had complete repair and excluded pts with coarctation, significant comorbidities and who were a part of the clinical practice guideline. Time to extubation (TTE) was assessed by duration and as day (8 am - 5 pm) vs. night (5 pm - 8 am). CCT was defined as the number of hours from ICU handoff to time the pt was medically ready to leave the ICU. Two sample t-tests were used to compare CCTs between day and night extubations. The relationship of TTE in hours and CCT was assessed using linear regression analysis. A sensitivity analysis was performed after exclusion of pts > median CCT of 50 hours. Results: A total of 144 pts (mean age 155 days, range 28-365 days; 59% males) were included. There was no difference in mean CCT for day (n=70) vs. night (n=74) extubations (104.3 + 18.8 vs. 76.0 + 9.2 hrs, p= 0.17). Overall, there was a strong correlation between TTE and CCT (r 2 0.88, p<0.001), for day extubations (r 2 0.94, p< 0.001) and night extubations (r 2 0.75, p<0.001). On the sensitivity analysis at <50 hours CCT, there was no difference in the mean CCT time for the day (n=30) vs. night (n=32) extubations (36.5 + 2.0 vs. 33.9 + 2.1 hrs, p= 0.39). Day extubations continued to have moderate correlation with CCT in <50 hrs (r 2 0.57, p<0.001) with a weaker correlation for the night group (r 2 0.34, p<0.001). There were 5 reintubations in the overall cohort (3.5%), 1 from the day (0.7%) and 4 from the night (2.8%). Conclusions: In this PHN CLS selective cohort of pts with ToF, our findings suggest that daytime vs nighttime extubation did not affect CCT. We also confirmed that those extubated earlier had shorter CCT. Further study into expanded pt groups is needed to assess impact on outcomes.