In operating room extubation after cardiac surgery is associated with decreased incidence of in hospital new postoperative atrial fibrillation

Objectives: This study aims to characterize the risks and benefits of in-OR extubation after cardiac surgery. Design: This is a retrospective chart review. Setting: Single tertiary care hospital. Participants: Cardiac surgical patients >18 years. Exclusion criteria included patients extubated after 6 h in the ICU, those with a history of congenital heart disease (CHD), those intubated prior to arrival to the OR, procedures including circulatory arrest and/or selective cerebral perfusion, cardiothoracic transplantation, and intraoperative death. De-identified data was collected via the hospital's electronic medical record. Interventions: None. Measurements and main results: Perioperative data was collected for 726 patients, of which 303 (42 %) were extubated in the OR. Multivariable regression models were derived with covariates based on expert clinical reasoning. When compared to fast track extubation, in-OR extubation was independently associated with decreased index hospitalization length of stay (-1.74, 95 % CI [-2.22, -1.08], p < 0.001) and decreased incidence of in-hospital new post-operative atrial fibrillation (OR 0.56 95 % CI [0.37, 0.86], p < 0.01). There were no differences in persistent vasoactive therapy requirement, postoperative mechanical circulatory support or extubation failure. Conclusions: In-OR extubation is associated with decreased index hospitalization length of stay and decreased new onset in-hospital atrial fibrillation.