In the Literature

Summary of "Operating Room Extubation in Major Aortic Surgery: Policy Change Leading to Improved Recovery"

Summary published November 9, 2026

Summary by Alex J. Horowitz, DO; Yong G. Peng MD, PhD, FASE, FASA

Journal of Cardiothoracic and Vascular Anesthesia | May 2026

Dimitrios E. Magouliotis, Serge Sicouri, Massimo Baudo, Yoshiyuki Yamashita, Shalin Patel, Corey Herman, Bilal Ahmad, Mark Berguson, Basel Ramlawi, Operating Room Extubation in Major Aortic Surgery: Policy Change Leading to Improved Recovery, Journal of Cardiothoracic and Vascular Anesthesia, Volume 40, Issue 8, 2026, Pages 2341-2350, ISSN 1053-0770, https://doi.org/10.1053/j.jvca.2026.05.009.

doi: https://doi.org/10.1053/j.jvca.2026.05.009

  • Patients undergoing complex open aortic surgery have traditionally remained intubated and mechanically ventilated in the postoperative period.
  • However, recent evidence suggests that prolonged mechanical ventilation following these surgeries may negatively impact patient outcomes, particularly postoperative morbidity, ICU length of stay, and resource utilization.
  • Based on this emerging data, a high-volume tertiary care academic medical center implemented a quality improvement intervention to establish OR extubation as the preferred strategy following complex open cardiac surgeries.
  • The authors of this retrospective, single-center observational cohort study examined the impact of this policy change (which resulted in OR extubation rates increasing from less that 5% to greater than 50%) on postoperative outcomes.
  • 658 adult patients undergoing aortic surgery between 2014 and 2025 were included in the study, with 191 (29%) extubated in the OR, and 467 (71%) extubated in the ICU.
  • Operating-room extubation was associated with a significant decrease in prolonged ICU stay (35% to 8%, p < 0.001), defined as ICU LOS exceeding the 75th percentile, or 124 hours, and median ICU LOS was significantly lower in the OR-extubation group (65.7 v 75.0 hours, p = 0.030).
  • No association was found between OR extubation and mortality, prolonged OR occupancy (time from skin closure to OR departure 22 mins [IQR, 16.5-29 mins] v 23 minutes [IQR, 17-30 minutes], p = 0.713), reintubation rates (0.9% vs 3.6%, p = 0.071), or other major complications as defined by the Society of Thoracic Surgeons.
  • A secondary analysis of outcomes pre- and post-implementation of the quality improvement intervention (implemented in mid-2020) similarly found lower rates of prolonged ICU stay without an increase in complications.
  • The authors concluded that OR extubation after major cardiac surgery was associated with lower ICU utilization without compromising patient safety.
  • Additional studies are needed to evaluate the role of residual confounding and selection bias, incorporate a concurrent control group to determine the influence of background practice changes, and analyze the influence of low-frequency complications in this single-center observational study.