Abstract
INTRODUCTION: The EuroSCORE II was updated from the EuroSCORE I and validated this year as a predictor for in-hospital mortality after cardiac surgery. The EuroSCORE I was previously shown in multiple studies to be a good predictor of delayed extubation in patients undergoing coronary artery bypass graft (CABG) surgery. In contrast, very few studies have been conducted on predictors of delayed extubation in patients undergoing valvular surgery. Identifying risk factors and predictors of prolonged intubation in patients undergoing valvular surgery will allow clinicians to address any modifiable risk factors, and optimize a high-risk patient's chances of a favorable outcome. The aim of this study is to evaluate the newly developed EuroSCORE II as an indicator for prolonged extubation following valvular surgery. The most common causes of delayed extubation in patients undergoing valvular surgery were also tabulated and analyzed. METHODS: We conducted a retrospective chart review on all patients in Queens Medical Center (QMC) from 1/1/2011 to 12/31/2011 who underwent any form of valvular surgery, either as a single procedure or in combination with another cardiothoracic procedure. The factors for patients who were intubated post surgery for 6 hours or more were identified and analyzed. Statistical analysis of the EUROscore as a predictor for the duration of intubation was performed. RESULTS: A total of 186 patients with a median age of 65, (39.8% females) were found to have had valvular surgery during the time period specified for our study. Forty-two (22.6%) patients were extubated within 6 hours, which is the definition of early extubation, in most studies. Strictly valve procedures comprised 66% with the rest being combinations (including CABG and aortic dissection repair). Procedures involving the aortic valve comprised 59%, involving the mitral valve, 46%; involving the tricuspid valve, 10% involving the pulmonary valve, 2%. Minimally invasive procedures were 7%. The most common causes of delayed extubations were hypoxia and bleeding. Statistical analysis of the EuroSCORE II showed that it correlated well with extubation times (P <.01). CONCLUSION: The majority of the patients undergoing valvular surgery in QMC are not extubated within the recommended time frame. The EuroSCORE II is a good predictor for prolonged extubation in patients following valvular surgery and may be useful in identifying patients at high risk for prolonged extubations, allowing clinicians to mitigate any modifiable risk factors in this group of patients.