Comparison of Short-Term Outcomes of Extubation in the Operating Room and Extubating in the Intensive Care Unit After Cardiac Surgery: Systematic Review and Meta-Analysis

Abstract

Objectives: This study aimed to compare short-term outcomes in patients extubated in the operating room (ORE) vs those extubated in the intensive care unit (ICUE) following cardiac surgery. Methods: A systematic search of MEDLINE and EMBASE was conducted from inception through September 2024. Pooled outcome estimates were calculated, and subgroup analyses were performed focusing on studies utilizing propensity score matching, weighting, or randomization. Results: Fourteen studies published between 2000 and 2024, encompassing 679,749 patients, were included. Of these, 6 utilized propensity score matching, 1 applied overlap weighting, and 1 employed randomization. Overall, ORE group had shorter aortic cross-clamp (P = 0.02) and cardiopulmonary bypass (P < 0.01) times. ORE patients had shorter ICU (P < 0.01) and hospital stays (P < 0.01). Rates of reintubation (P = 0.78), reoperation for bleeding (P = 0.18), prolonged mechanical ventilation (P = 0.12), and hospital readmission (P = 0.71) were comparable between the groups. Postoperative stroke rate (P < 0.01) and short-term mortality (P = 0.04) were lower in the ORE group. In the subgroup analysis, ICU stay, hospital stay, and cardiopulmonary bypass time remained shorter in ORE groupfund, while reoperation for bleeding was significantly higher (P < 0.01). However, the differences in postoperative stroke (P = 0.52) and short-term mortality (P = 0.42) were no longer statistically significant. Conclusion: This meta-analysis demonstrates that ORE after cardiac surgery can be performed in selected patients, with comparable postoperative outcomes to ICUE. The ORE strategy may result in shorter ICU and hospital stays.