Incidence, Risk Factors, and Clinical Outcomes of Postoperative Reintubation after Planned Extubation in Adults Undergoing General Anesthesia: A Single-center Experience

Abstract

Objective: Postoperative reintubation after planned extubation (PRAP) is a complication following general anesthesia. This study aimed to determine the incidence, risk factors, and outcomes in a tertiary-care university hospital. Materials and Methods: A retrospective case-control study was conducted between 2014 and 2022. The PRAP group included patients requiring reintubation within 2 h after planned extubation following general anesthesia, while the control group included patients who did not require reintubation. Cases and controls were matched in a 1:3 ratio, with time-matched controls randomly selected within 2 weeks. Descriptive statistics and logistic regression were utilized for analysis. Results: Of 139,103 patients, 88 PRAP cases were identified, yielding an incidence of 0.06% (95% Confidence Interval [CI], 0.05–0.08). Multivariate analysis revealed independent risk factors associated with PRAP: the American Society of Anesthesiologists Physical Status (ASA) ≥ III (adjusted odds ratio [aOR], 2.72; 95% CI, 1.58–4.66; P < 0.001), hemoglobin < 12 g/dL (aOR, 1.76; 95% CI, 1.02–3.01; P = 0.041), creatinine clearance < 60 mL/min (aOR, 3.38; 95% CI, 2.16–5.30; P < 0.001), and chronic obstructive pulmonary disease (COPD) (aOR, 18.73; 95% CI, 1.60–219.22; P = 0.020). PRAP was associated with increased 30-day mortality, cardiac arrest, and prolonged length of hospital and intensive care unit stay (all, P < 0.001). Conclusion: The incidence of PRAP was 0.06%. Independent risk factors associated with PRAP were ASA, hemoglobin, creatinine clearance, and COPD. PRAP is associated with adverse postoperative outcomes, highlighting the need for preventive strategies and careful perioperative management.