Impact of tracheal extubation location after surgical procedures on peri-operative times: a prospective dual-centre observational study.

Background: Extubation of the trachea in the operating theatre may increase the time spent there. Conversely, tracheal extubation in the post-anaesthesia care unit may prolong the duration of anaesthesia and increase the incidence of complications. Our primary objective was to quantify the additional occupancy time associated with tracheal extubation in the operating theatre compared with the post-anaesthesia care unit. Secondary objectives were to assess the incidence of complications after tracheal extubation, including the need for ventilatory support.

Methods: This was a prospective dual-centre observational cohort study of patients whose tracheas were intubated for surgery in the operating theatre of two university hospitals. The primary endpoint was operating theatre occupancy time between the end of surgical procedure and discharge from the operating theatre.

Results: In total, 756 patients were included, and 494 (65.3%) tracheal extubations occurred in the operating theatre. Room occupancy time was increased by 7 min (95%CI 5-8 min, p = 0.001) when tracheal extubation was performed in the operating theatre compared with the post-anaesthesia care unit. After adjustment by matched or weighted propensity score, this time increased to 8 min (95%CI 6-10 min, p = 0.001) and 8 min (95%CI 6-9 min, p = 0.001), respectively. Desaturation after tracheal extubation (20.9% vs. 36.3%, p < 0.001) and arterial hypotension (0.6% vs. 3.1%, p = 0.019) were less frequent when tracheal extubation took place in the operating theatre.

Conclusions: Tracheal extubation in the operating theatre is associated with an increase in theatre occupancy of < 8 min and a lower incidence of postoperative respiratory and cardiovascular complications.