Extubation in the Operating Room After Transapical Transcatheter Aortic Valve Implantation Safely Improves Time-Related Outcomes and Lowers Costs: A Propensity Score-Matched Analysis

J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1751-1759. doi: 10.1053/j.jvca.2020.08.004. Epub 2020 Aug 7.

Abstract

Objective: The experience of safe extubation in the operating room (OR) after transcatheter aortic valve implantation (TAVI) procedure remains not well established. The authors conducted this study to assess the effect of OR extubation in comparison with extubation in the intensive care unit (ICU) on the outcomes and cost in patients undergoing transapical-TAVI.

Design: A propensity score-matched analysis.

Setting: A single major urban teaching and university hospital.

Participants: A total of 266 patients undergoing transapical TAVI under general anesthesia between June 2015 and March 2020.

Interventions: Propensity matching on pre- and intraoperative variables was used to identify 99 patients undergoing extubation in the OR versus 72 undergoing extubation in the ICU for outcome analysis.

Measurements and main results: After matching, extubation in the OR showed significant reductions of length of stay (LOS) in ICU (38.8 ± 17.4 v 58.0 ± 70.0 h, difference -19.2, 95% confidence interval [CI] -35.7 to -2.7, p = 0.009) and postoperative LOS in hospital (7.1 ± 3.9 v 10.1 ± 4.6 d, difference -3.0, 95% CI -4.3 to -1.7, p < 0.0001) compared with ICU extubation, but did not significantly affect the composite incidence of any postoperative complications (46.5% [46 of 99] v 52.8% [38 of 72], difference -6.3%, 95% CI -21.5 to 8.9, p = 0.415). Also, extubation in the OR led to significant reduction of total hospital cost compared with extubation in the ICU (¥303.5 ± 17.3 v ¥329.9 ± 52.3 thousand, difference -26.2, 95% CI -38.8 to -13.7, p < 0.0001).

Conclusions: The current study provided evidence that extubation in the OR could be performed safely without increases in morbidity, mortality, or reintubation rate and could provide cost-effective outcome benefits in patients undergoing transapical-TAVI.

Keywords: Extubation; complication; hospital cost; length of stay; transcatheter aortic valve replacement.

MeSH terms

  • Airway Extubation
  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / surgery
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Humans
  • Operating Rooms
  • Postoperative Complications / epidemiology
  • Propensity Score
  • Retrospective Studies
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome