Application of a risk score for postoperative reintubation within two hours after planned extubation during general anesthesia: A matched case-control study

Literature on risk factors for reintubation within 2 hours after planned or actual extubation is limited due to the current definition of anesthesia-related complications. This study aimed to assess risk factors and develop a predictive score for reintubation within 2 hours after planned extubation. In this matched case-control study, we collected data from patients who underwent general anesthesia with intubation and extubation at the end of surgery between 2014 and 2021. A reintubation case was defined as one occurring 2 hours after planned extubation in the operating theater, post-anesthetic care unit, or ward. A risk score was derived from the coefficients of the significant predictors in the final multivariate conditional logistic regression model. Risk scores, adjusted odds ratios (ORs), and 95% confidence intervals (CIs) were determined. Of 101,427 patients in our database who were intubated during the study period, 93,287 were eligible for inclusion, of which 107 cases and 428 controls were selected. Our risk prediction tool for postoperative reintubation had a sensitivity of 60% and a specificity of 82%. Anesthesia-specific predictors of reintubation were deep extubation (OR [95% CI]: 8.5 [1.7-42.8], score of 21) and use of fentanyl (vs morphine) (OR [95% CI]: 4.9 [1.7-13.6], score of 16), whereas use of succinylcholine (vs cisatracurium) (OR [95% CI]: 0.11 [0.01-0.99], score -22) and successful extubation within 10 minutes after anticholinesterase administration (OR [95% CI]: 0.5 [0.3-0.9], score -7) were protective factors. Intra-abdominal, vascular, intrathoracic, and airway operations were surgery-specific predictors (score of 11-14) whereas current smoking status (OR [95% CI]: 3.1 [1.3-7.6], score of 11) and pulmonary disease (OR [95% CI]: 2.4 [1.04-5.5], score of 9) were patient-specific risk factors. Our risk score for postoperative reintubation recommends performing extubation when the risk score is ≤ 37. If the risk score is > 37, extubation using the awake technique and fulfilling the criteria within 10 minutes of anticholinesterase administration under train-of-four monitoring should be considered to reduce the risk of reintubation.