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  • Title: Safety and efficacy of early extubation of elderly coronary artery bypass surgery patients.
    Author: Lee JH, Graber R, Popple CG, Furey E, Lyons T, Murrell HK, Geha AS.
    Journal: J Cardiothorac Vasc Anesth; 1998 Aug; 12(4):381-4. PubMed ID: 9713722.
    Abstract:
    OBJECTIVE: Early extubation and fast-track management protocols on younger, low-risk patients result in shorter hospital stays and decreased costs. The impact of such protocols on elderly patients undergoing coronary artery bypass graft (CABG) surgery is not presently known. DESIGN: A matched retrospective cohort study. SETTING: A university teaching hospital. PARTICIPANTS: Six hundred ninety-eight consecutive patients undergoing isolated CABG between January 1995 and September 1996. INTERVENTIONS: Three hundred seventy-seven patients underwent early extubation, defined as extubation within 8 hours of arrival in the intensive care unit. They were divided into groups of patients 70 years of age and younger (n = 263) and patients older than 70 years of age (n = 114). RESULTS: The mean length of stay (LOS) for all patients extubated within 8 hours or less was 5.5 days versus 8.4 days for patients who underwent later extubation (p < 0.0001). The percentage of patients undergoing early extubation was greater for the younger cohort (59% v 48%; p < 0.003) compared with the older cohort of patients. Analysis of demographics showed the older patients to have a greater incidence of peripheral vascular disease, congestive heart failure, and prior strokes (p < 0.05). Although the intensive care unit LOS was similar, postoperative LOS was 5.3 +/- 1.8 days for the younger patients versus 6.1 +/- 2.6 days for the older patients (p = 0.001). The overall surgical mortality rate was 2.6% (18/698), and there were no deaths among patients undergoing early extubation. Reintubation rate was negligible in both groups of patients. CONCLUSION: This study confirms the safety and efficacy of early extubation among elderly patients undergoing CABG. Elderly patients have more comorbid conditions, yet a significant number can be extubated early, with resultant shortened LOSs.
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