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Obesity is a risk factor for failure of "fast track" extubation following coronary artery bypass surgery

[L’obésité est un facteur de risque d’échec de l’extubation «précoce» à la suite d’un pontage aortocoronarien]

From the Department of Anesthesiology, Queen’s University, Kingston, Ontario, Canada.

Address correspondence to: Dr. Joel Parlow, Department of Anesthesiology, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Phone: 613-548-7827; Fax: 613-548-1375. E-mail: parlowj{at}post.queensu.ca

Purpose: Obesity is a common comorbid condition among patients undergoing coronary bypass surgery. Previous studies have shown inconsistent results as to whether obese patients require prolonged ventilation after cardiac surgery. Fast track recovery strategies have become common to reduce the duration of ventilation and intensive care. The purpose of this study was to determine whether, in our practice, obesity affects post-operative ventilation time using a fast track recovery strategy.

Methods: A retrospective continuous quality improvement audit of 200 patient records was performed. Patients were divided into Obese and Non-obese groups using a definition for obesity of body mass index 30.0. Failure of fast track extubation was defined as intubation > six hours.

Results: Eighty-four (42.4%) of the patients audited met criteria for obesity. Although most patients successfully underwent fast track recovery, time to extubation was prolonged, and failure of fast track extubation was more common, in obese patients (63% Non-obese vs 46% Obese extubated in < two hours, 98% Non-obese and 85% Obese patients extubated in < six hours, P < 0.001). Increased body mass index, duration of operative time and postoperative serum creatinine were risk factors for failed fast track extubation among the obese patients. Postoperative blood loss through chest drains was reduced in obese patients.

Conclusions: While most obese patients can undergo a fast track recovery strategy following cardiac surgery, in our institution the incidence of failure of early extubation is significantly higher than in non-obese patients. Our experience may assist in resource planning for postcardiac surgery patients.