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Original Article
Nursing Predictors of delayed extubation post–coronary artery bypass graft and its relationship with length of stay and in-hospital mortality in Jordan

DOI: https://doi.org/10.4266/acc.003432
Published online: May 19, 2026

1Faculty of Nursing, Yarmouk University, Irbid, Jordan

2Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE

3Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt

4Department of Clinical Nursing, Faculty of Nursing, Applied Science Private University, Amman, Jordan

5Faculty of Nursing, Applied Science Private University, Amman, Jordan

Corresponding Author: Mohannad Eid Aburuz Faculty of Nursing, Yarmouk University, Irbid 21163, Jordan Tel: +962-272-1111, Fax: +962-2721-1152 Email: mohannadeid@yahoo.com
• Received: August 29, 2024   • Revised: February 22, 2026   • Accepted: March 9, 2026

© 2026 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background
    Coronary artery bypass graft (CABG) surgery is an invasive procedure done to resolve symptoms and improve quality of life in patients with coronary artery disease. However, it is a major operation that has its own complications and risks. Delayed extubation (DE) after surgery has been associated with higher-than-average rates of morbidity and mortality. The objective of this study was to determine the incidence and most important predictors of DE following CABG surgery.
  • Methods
    This prospective observational study was conducted on 300 adult patients who underwent non-urgent CABG. Data were collected from 4 hospitals in Alexandria, Egypt, by trained research assistants and were analyzed using logistic regression, independent t-test, and Fisher's exact test.
  • Results
    Seventy-five participants (25%) developed DE. Patients with age ≥60 years, operation time ≥7 hours, cardiopulmonary bypass time ≥120 minutes, or body mass index ≥28 kg/m2 had a 1.71, 1.88, 2.25, or 2.33 times higher risk of developing DE than those in the counterpoint groups. The only protective variable was the ejection fraction (EF). Patients with EF ≥50% were 21% less likely to develop DE than those with EF less than 50%. Participants who developed DE stayed longer in the intensive care unit (mean±standard deviation [SD], 7.9±1.60 vs. 3.1±1.2; P<0.001) and in the hospital (mean±SD, 22.6±3.1 vs. 15.1±2.9; P<0.001) than those who did not develop DE.
  • Conclusions
    Performing CABG as early as possible, controlling body mass index, shortening the operation and cardiopulmonary bypass times, and enhancing EF might decrease the occurrence of postoperative DE and its associated mortality.
  • Key Words: coronary artery bypass graft surgery; delayed extubation; intensive care unit; length of stay; mortality
Postoperative mechanical ventilation is routinely used after coronary artery bypass graft (CABG) surgery to minimize myocardial oxygen consumption and the work of spontaneous ventilation [1]. High intra-operative doses of opioids and postoperative analgesia extend the intubation period [2]. Even though a high percentage of CABG patients can be extubated with no delay, weaning from mechanical ventilation remains a challenge that can result in delayed extubation (DE) or reintubation. Reintubation usually happens in patients who were extubated early without taking into consideration factors that affect extubation [3-5]. Reintubation within the first two days after surgery or postoperative mechanical ventilation lasting more than 48 hours can be considered DE [3]. DE can have adverse effects, including hemodynamic instability, increased risk of pulmonary infections, acute kidney injury, delirium, patient discomfort from the endotracheal tube, increased intensive care unit (ICU) length of stay (LoS), increased healthcare costs, and increased in-hospital mortality [1,3,6-9].
As a result, clinical paths have been established to expedite patient recovery from heart surgery [10]. For example, patients can be moved from the ICU to the intermediate-care unit on day of surgery, given low-dose or short-acting anesthetics, and extubated early (i.e., less than 48 hours after their operation) [2,11]. Differences in practice patterns and safety concerns about the different degrees of monitoring and nurse-to-patient ratios [12] between the ICU and medical wards have been used to explain the varied outcomes linked to fast-track pathways [13,14]. Given the risks, it is critical to identify people at risk of DE early [1,9].
The risk of DE following cardiac CABG surgery can be predicted precisely through a comprehensive assessment of preoperative parameters [1,9]. However, the use of the prediction models in clinical practice has been restricted due to problems with sample size and the evaluation procedures used in those investigations. Additionally, those studies were primarily conducted in developed countries. A cutting-edge predictive model that can be broadly applied in developing countries is still needed due to differences in lifestyle, income, and medical resources.
Therefore, we aimed to: (a) assess the incidence of DE post-CABG surgery; (b) identify the most important predictors of DE post-CABG surgery; (c) determine whether the LoS in the ICU and hospital differed by DE status (delayed vs. non-delayed) post-CABG surgery; and (d) determine whether the mortality rate differed by DE status (delayed vs. non-delayed) post-CABG surgery. The findings of this study can be applied to help medical professionals determine the probability of DE and suitably allocate medical resources in the initial postoperative period following CABG surgery.
Ethical Considerations
This study was reviewed and approved by the Ethical and Research Committee at Alexandria University and by the selected hospitals before data collection (IRB00013620 [19/9/2025]). All patients who agreed to participate in the study signed an informed consent form, including permission to review their medical records. All participants received a detailed explanation of the study, its benefits, and risks. They were assured that their participation was voluntary and that they could withdraw at any time without consequences. All data were coded and kept in a password-protected computer, and aggregate data were used for this publication.
Design, Sample, and Setting
A non-experimental, prospective, observational design was used to meet the objectives of this study. A consecutive sampling technique was used. All patients who visited the cardiothoracic surgery outpatient clinics of four hospitals (one governmental, one teaching, and two private) in Alexandria, Egypt, were screened for the following eligibility criteria: (1) aged 18 years or older, (2) able to read and write Arabic, (3) non-emergency surgery, (4) no preoperative mechanical ventilation, (5) no combination with non-cardiac surgeries such as lobectomy. Patients were excluded from the study if they had clinical data loss.
To ensure that the sample size was sufficient to reach statistical significance and meet the objectives of this study, two steps were taken: (1) A logistic regression sample-size calculator was used to determine predictors of DE. The criteria assumed an estimated event rate (occurrence DE) of 20% [3], a two-tailed test with a power of 0.8, 16 independent variables, and an alpha of 0.05. Based on those assumptions, the required sample size was 232 patients. (2) An independent t-test was used to assess the difference in LoS between those who developed DE and those who did not. The assumptions for that test were a two-tailed test, type I error of 0.05, and power of 0.8. Based on those assumptions, the required sample was 128 patients. Therefore, we recruited 300 participants (Figure 1).
Procedure
Well-trained research assistants holding master’s degrees in critical care approached all participants at the cardiothoracic surgery clinics who met the inclusion criteria, explained the study in detail, and answered participants’ questions. Before surgery (mean±standard deviation [SD], 20±14 hours), participants filled out a sociodemographic questionnaire that collected their sex, age, marital status, and working status. All other needed information was collected from the medical records after discharge: history of hypertension or diabetes mellitus, previous myocardial infarction, previous angina, smoking, ejection fraction (EF), body mass index (BMI; kg/m2), cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) time, transfusion of blood products, operative duration and use of intra-aortic balloon pump, pre- and postoperative hemoglobin levels, estimated glomerular filtration rate, postoperative hospital LoS, ICU LoS, and in-hospital mortality.
Study Outcomes
Patients were considered to have DE if extubation occurred more than 48 hours postoperatively or if the patient required reintubation during that period [3]. LoS was collected from medical records after discharge and recorded in days for both the ICU LoS and total hospital LoS. In-hospital mortality was also collected from medical records.
Data Analysis
The IBM SPSS version 26 (IBM Corp.) was used to analyze the data, and any p-value less than 0.05 was considered statistically significant. For aim (a), which assessed the incidence of DE following CABG surgery, numbers and percentages were used. For aim (b), which identified key predictors of DE, continuous variables were converted into categorical ones based on clinically relevant and practical thresholds: age ≥60 years, EF ≤ 50%, operation time ≥7 hours, CPB ≥120 minutes, and BMI ≥28 kg/m² [3]. A two-step analysis was conducted: (1) Point-biserial correlations were used to assess relationships between the independent variables and the dependent variable (DE); (2) Variables showing significant correlations were entered into a logistic regression model. For aim (c), which evaluated whether hospital and ICU LoS differed between the delayed and non-delayed groups, two independent-samples t-tests were performed—one for hospital LoS and one for ICU LoS. For aim (d), which assessed differences in the mortality rate between groups, Fisher’s exact test was used to provide a conservative interpretation because the total number of deaths was 6 (5 in the DE group and 1 in the non-DE group).
Demographics and Clinical Characteristics
In total, 300 patients were included in this study: 200 men and 100 women. The mean age was approximately 60 years, and most of the participants (240, 80%) were married. More than half of the patients were current smokers, had hypertension, or BMI ≥28 kg/m2, and nearly three-quarters had previous angina (Table 1).
Pre- and Postoperative Information
More than one-third of the sample had a CPB time ≥120 minutes. Ninety patients (30%) had an operation duration of ≥7 hours. Cryoprecipitate was the most common blood component transferred after the operation. Sixty percent of the participants were anemic before the operation, compared with 84% postoperatively. Two percent of the participants died during hospitalization (Table 1).
Compared with those who did not develop DE, patients who developed DE were older and had more comorbidities, including a history of previous myocardial infarction and diabetes. They were also more obese, had lower EF, and had longer surgery and ACC durations. They stayed at the hospital and ICU longer than those who did not develop DE. No other significant differences in demographic or clinical characteristics were observed between the groups (Table 1).
Predictors of DE Post-CABG Surgery
The correlations and logistic regression models in Tables 2 and 3 show that 5 predictors for the development of DE were found. Patients aged ≥60 years had a 1.71 times higher risk of developing DE than those aged less than 60 years. Patients with an operation time ≥7 hours were at 1.88 times higher risk for developing DE than those whose operation time was less than 7 hours. Patients with CPB time ≥120 minutes were at 2.25 times higher risk of developing DE than those with a CPB time less than 120 minutes. Patients with a BMI ≥28 kg/m2 were at 2.33 times higher risk for developing DE than those with a BMI less than 28 kg/m2. The only protective variable was EF: patients with EF ≥50% were 21% less likely to develop DE than those with EF less than 50%.
Differences in ICU and Hospital LoS by DE Status Post-CABG Surgery
Participants who developed DE stayed in the ICU (mean±SD, 7.9±1.60 vs. 3.1± 1.2; P<0.001) and hospital (mean±SD, 22.6± 3.1 vs. 15.1± 2.9; P<0.001) longer than those who did not develop DE (Table 4).
Mortality Rate Difference by DE Status Post-CABG Surgery
Six patients (2%) in the total sample died during hospitalization; five of them were in the DE group, with only one patient in the non-delayed group. Fisher’s exact test was performed and indicated a significant difference (P=0.021) between the groups.
The goal of this study was to assess the incidence of DE post-CABG surgery, identify the most important predictors of DE post-CABG surgery; and determine differences in the ICU LoS, hospital LoS, and mortality rate according to DE status (delayed vs. non-delayed) post-CABG surgery. It had already been established that early extubation (known as fast-track extubation) after cardiac surgery reduces postoperative complications and morbidity, hospital LoS, and cost [15]. Therefore, determining factors that contribute to DE is essential for improving patient outcomes.
Incidence of DE Post-CABG Surgery
Overall, 75 participants (25%) developed DE after CABG surgery. In this study, we considered postoperative extubation to be delayed if mechanical ventilation lasted more than 48 hours or the patient was reintubated within the first 2 days after surgery [3]. The incidence of DE post-CABG reported in recent literature varies widely. For instance, Li et al. [3] found that the frequency of DE after cardiac surgery (including CABG) was 13.6%, whereas Gumus et al. [16] reported that only 5.6% of post-CABG patients required prolonged postoperative ventilation. Both of those studies defined DE as extubation occurring more than 48 hours after surgery. On the other hand, Kotfis et al. [7] reported an incidence of 3.7% for intubation time greater than 24 hours after CABG. Variation in participants’ demographic and clinical characteristics could contribute to the higher incidence of DE observed in this study, compared with previous studies [3,16]. Our results also demonstrate significant correlations between DE and participants’ demographic and clinical variables, which supports that explanation. Moreover, variations in perioperative management, including differences in anesthesia techniques, postoperative care protocols, and extubation criteria, can influence the timing of extubation.
Predictors of DE Post-CABG Surgery
DE post-CABG is influenced by several personal and intra-operative variables: age, BMI, EF, operation time, and CPB time. First, age should be considered when predicting the likelihood of DE in patients undergoing cardiac surgery [3,17]. Advanced age is associated with both frequent comorbidities and alterations in pulmonary function. According to Cho and Stout-Delgado [18], normal lung aging causes anatomical and functional alterations in the respiratory tract that lead to diminished lung function and therefore DE.
Second, high patient weight is associated with DE post-CABG surgery [19]. Specifically in our study, overweight patients (BMI ≥28 kg/m2) had a higher risk of DE than those with a BMI <28 kg/m2. This finding supports the risk-prediction model developed by Li et al. [3] that identified 10 risk factors associated with DE after cardiac surgery, including BMI ≥28 kg/m2. Along the same line, although some overweight patients can tolerate fast-track extubation, they have a higher incidence of early extubation failure and require a longer time for extubation than non-obese patients [20]. This association can also be explained by the comorbidities and body alterations associated with being overweight.
On the other hand, EF, which measures the heart’s pumping efficiency, acts as a protective factor against DE in patients undergoing CABG surgery. In particular, a better EF has been linked to a lower risk of prolonged intubation, which is consistent with the results reported by Rahimi et al. [21]. Evidently, low cardiac output leads to hemodynamic instability, the use of inotropic and vasoactive medications, and consequently failure to meet the weaning criteria for mechanical ventilation [17,21,22].
In terms of operative variables, our results are consistent with those of previous studies, which reported that prolonged operation time and CPB time are significant risk factors for DE in open heart surgeries, including CABG [23,24] and aortic dissection surgery [1]. The synthetic circuit of the extracorporeal circulation triggers an inflammatory response and causes ischemia–reperfusion injury, which can lead to pulmonary complications such as altered gas exchange, transient hypoxemia, or even acute respiratory distress syndrome [25]. Those pulmonary complications make it more difficult for the respiratory system to function independently, consequently delaying extubation after surgery. Although previous studies reported different cut points for CPB, we found that CPB time ≥120 minutes doubled the risk of developing DE post-CABG surgery.
Differences in ICU and Hospital LoS by DE Status Post-CABG Surgery
DE contributes to a higher incidence of postoperative complications, including the use of continuous renal replacement therapy, neurological complications [3], and delirium [26], leading to prolonged ICU and hospital LoS. Taylor et al. [15] summarized the evidence from four randomized trials that reported ICU LoS based on the extubation time after cardiac surgery. Extubation occurred in the operating room in two of those studies, within six hours of surgery in one, and within eight hours of surgery in one. They concluded that early extubation after cardiac surgery significantly reduces ICU LoS. Similarly, a retrospective analysis of 1,904 patients undergoing CABG revealed that patients extubated ≤12 hours after CABG had lower 30-day mortality and shorter ICU and hospital LoS than those intubated for >12 hours [7].
Differences in the Mortality Rate by DE Status Post-CABG Surgery
Although only 6 patients died during hospitalization in our study population, almost 84% of them were in the DE group. A large-scale study that examined the effects of immediate versus DE in 52,982 patients admitted to ICUs postoperatively in Austria found that day 2 extubation, as opposed to day 1 extubation, was an independent risk factor for in-hospital mortality. In general, postoperative DE affects the mortality rate [1]. A comparison of clinical outcomes specific to CABG surgeries in patients with and without DE showed that DE contributes to a higher incidence of postoperative complications, cardiac arrest, and death [3].
This study has limitations. Organizational and systemic variables were not measured in this study, which might have affected the results by failing to account for the possible effects of those variables on the DE predictors. Those variables should be incorporated in future studies.
The incidence of DE among patients post-CABG surgery was 25%. Diverse risk factors affect the likelihood of DE, among which some are modifiable and others are not. Working on the modifiable risk factors, such as lowering BMI, improving EF, and shortening the operation time, might decrease the incidence of DE and its associated morbidity, mortality, and long LoS.
▪ Patient age ≥60 years, operation time ≥7 hours, cardiopulmonary bypass time ≥120 minutes, and body mass index ≥28 kg/m2 were independent predictors of an increased risk for delayed extubation (DE).
▪ Ejection fraction levels ≥50% are protective against DE.
▪ DE is associated with higher-than-average mortality and morbidity and longer length of stay.
▪ Controlling modifiable risk factors for DE might improve the outcomes of cardiac surgery.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

ACKNOWLEDGMENTS

Our sincere appreciation goes to all participants of the present study.

AUTHOR CONTRIBUTIONS

Conceptualization: MEA, FRA, HIAM, EO, AAH, RG, ARS. Methodology: MEA, FRA, HIAM, EO, AAH, RG, ARS. Software: MEA, FRA, HIAM, EO, AAH, RG, ARS. Validation: MEA, FRA, HIAM, EO, AAH, RG, ARS. Formal analysis: MEA, FRA, HIAM, EO, AAH, RG, ARS. Investigation: MEA, FRA, HIAM, EO, AAH, RG, ARS. Resources: MEA, FRA, HIAM, EO, AAH, RG, ARS. Data curation: MEA, FRA, HIAM, EO, AAH, RG, ARS. Visualization: MEA, FRA, HIAM, EO, AAH, RG, ARS. Project administration: MEA, FRA, HIAM, EO, AAH, RG, ARS. Writing - original draft: MEA, FRA, HIAM, EO, AAH, RG, ARS. Writing - review & editing: MEA, FRA, HIAM, EO, AAH, RG, ARS. All authors read and agreed to the published version of the manuscript.

Figure 1.
Patient flow diagram.
acc-003432f1.jpg
Table 1.
Demographic and clinical characteristics based on extubation category
Variable Total group (n=300) DE (n=75) Non-DE (n=225) P-value
Sex ≥0.05
 Male 200 (66.7) 50 (66.7) 150 (66.7)
 Female 100 (33.3) 25 (33.3) 75 (33.3)
Age (yr) 60±12 61±7 50±8 0.04
Age group (yr) ≥0.05
 <40 21 (7.0) 5 (6.7) 16 (7.1)
 40–49 52 (17.3) 13 (17.3) 39 (17.3)
 50–59 97 (32.3) 24 (32.0) 73 (32.4)
 60–69 97 (32.3) 25 (33.3) 72 (32.0)
 ≥70 33 (11.0) 8 (10.7) 25 (11.1)
Marital status ≥0.05
 Single 40 (13.3) 9 (12.0) 31 (13.8)
 Married 240 (80.0) 60 (80.0) 180 (80.0)
 Divorced/widowed 20 (6.7) 4 (5.3) 16 (7.1)
Working status ≥0.05
 Currently working 180 (60.0) 47 (62.7) 137 (60.9)
 Not working/retired 120 (40.0) 28 (37.3) 92 (40.9)
Smoking status ≥0.05
 Currently smoking 168 (56.0) 40 (53.3) 128 (56.9)
 Previously smoking 92 (30.7) 25 (33.3) 67 (29.8)
 Never smoked 40 (13.3) 10 (13.4) 30 (13.3)
BMI (kg/m2) 29.61±5.43 27.5±3.6 23.9±2.3 <0.001
BMI category (kg/m2) ≥0.05
 <28 120 (40.0) 28 (37.3) 92 (40.9)
 ≥28 180 (60.0) 47 (62.7) 133 (59.1)
EF 50.91±7.50 37.4±6.0 40.0±4.1 <0.001
EF Category ≥0.05
 <50% 138 (46.0) 32 (42.7) 106 (47.1)
 ≥50% 162 (54.0) 43 (57.3) 119 (52.9)
Comorbidity
 HTN 160 (53.3) 38 (50.7) 122 (54.2) ≥0.05
 COPD 13 (4.3) 37 (49.3) 104 (46.2) ≥0.05
 DM 141 (47.0) 63(84.0) 78 (34.7) <0.001
Previous angina 215 (71.7) 56 (74.7) 159 (70.7) ≥0.05
 Previous MI 105 (35.0) 48 (64.0) 57 (25.3) <0.001
 Heart failure 9 (3.0) 3 (4.0) 6 (2.7) ≥0.05
Cardiopulmonary bypass time (min) 120.45±50.0 123.10±48.7 119.60±50.5 ≥0.05
Cardiopulmonary bypass time (min) ≥0.05
 <120 194 (64.7) 46 (61.3) 148 (65.8)
 ≥120 106 (35.3) 29 (38.7) 77 (34.2)
Aortic cross clamp time (min) 76.40±32.12 75.3±30.4 40.1±11.6 <0.001
Operation duration (hr) 5.9±1.82 6.4±1.0 5.6±.90 0.039
Operation duration (hr) ≥0.05
 <7 210 (70.0) 50 (66.7) 160 (71.1)
 ≥7 90 (30.0) 25 (33.3) 65 (28.9)
Blood product transfusion ≥0.05
 PRBC 2.72±0.91 32 (42.7) 88 (39.1)
 Platelets 3.78±1.88 12 (16.0) 33 (14.7)
 FFP 1.77±1.68 18 (24.0) 42 (18.7)
 Cryoprecipitate 5.0±1.5 5 (6.7) 13 (5.8)
Use of IABP 12 (4.0) 3 (4.0) 9 (4.0) ≥0.05
Preoperative hemoglobin 13.1±1.8 12.9±1.7 13.2±1.8 ≥0.05
 Anemic (less than13.5 g/dl) 180 (60.0) 43 (57.3) 137 (60.9)
 Normal 120 (40.0) 32 (42.7) 88 (39.1)
Postoperative hemoglobin 10.93±1.2 10.85±1.3 10.96±1.2 ≥0.05
 Anemic (less than13.5 g/dl) 252 (84.0) 62 (82.7) 190 (84.4)
 Normal 48 (16.0) 13 (17.3) 35 (15.6)
Estimated glomerular filtration rate 94.1±1.9 93.8±1.8 94.2±1.9 ≥0.05
Reintubation within 48 hr 5 (1.7) 1 (1.3) 4 (1.8) ≥0.05
Died during hospitalization 6 (2.0) 5 (6.7) 1 (0.04) 0.021

Values are presented as number (%) or mean±standard deviation.

DE: delayed extubation; BMI: body mass index; EF: ejection fraction; HTN: history of hypertension; COPD: history of chronic obstructive pulmonary disease; DM: diabetes mellitus; MI: myocardial infarction; PRBC: packed red blood cell; FFP: fresh frozen plasma; IABP: intra-aortic balloon pump.

Table 2.
Significant correlations between DE and demographic and clinical variables
Variable Age BMI EF HTN MI CPB time Cross clamp time Operation time Preoperative hemoglobin
DE 0.45a) 0.50a) –0.51a) 0.17b) 0.32a) 0.56a) 0.55a) 0.61a) –0.49a)

DE: delayed extubation; BMI: body mass index; EF: ejection fraction; HTN: hypertension; MI: myocardial infarction; CPB: cardiopulmonary bypass.

a)P<0.001.

b)P<0.05.

Table 3.
Independent predictors of delayed extubation by Binary logistic regression
Variable β Wald P-value OR 95% CI
EF ≥50% –0.41 8.61 0.004 0.79 0.73–0.96
Age ≥60 yr 0.56 11.62 0.003 1.71 1.03–2.91
Operation time ≥7 hr 0.64 18.61 0.002 1.88 1.08–3.39
CPB time ≥120 min 0.82 19.31 <0.001 2.25 1.69–3.40
BMI ≥28 kg/m2 0.92 19.80 <0.001 2.33 1.75–3.44

Variables were entered in the logistic regression as independent variables were: Block 1: age, BMI, history of hypertension, and history of myocardial infarction, Block 2: EF, CPB time, cross clamp time, operation time, and Preoperative hemoglobin.

OR: odds ratio, EF: ejection fraction; CPB: cardiopulmonary bypass; BMI: body mass index.

Table 4.
The difference in the ICU and hospital LoS based on the DE group
Variable Delayed extubation group (n=75) Non- delayed extubation group (n=225) P-value
ICU LOS 7.9±1.6 3.1±1.2 <0.001
Hospital LOS 22.6± 3.1 15.1±2.9 <0.001

Values are presented as mean±standard deviation in days.

ICU: intensive care unit; LoS: length of stay; DE: delayed extubation.

  • 1. Maisat W, Siriratwarangkul S, Charoensri A, Wongkornrat W, Lapmahapaisan S. Perioperative risk factors for delayed extubation after acute type A aortic dissection surgery. J Thorac Dis 2020;12:4796-804.ArticlePubMedPMC
  • 2. MacLeod JB, D'Souza K, Aguiar C, Brown CD, Pozeg Z, White C, et al. Fast tracking in cardiac surgery: is it safe? J Cardiothorac Surg 2022;17:69.ArticlePubMedPMCPDF
  • 3. Li X, Liu J, Xu Z, Wang Y, Chen L, Bai Y, et al. Early identification of delayed extubation following cardiac surgery: development and validation of a risk prediction model. Front Cardiovasc Med 2022;9:1002768.ArticlePubMedPMC
  • 4. Herlihy JP, Koch SM, Jackson R, Nora H. Course of weaning from prolonged mechanical ventilation after cardiac surgery. Tex Heart Inst J 2006;33:122-9.PubMedPMC
  • 5. Liu LL, Gropper MA. Respiratory and hemodynamic management after cardiac surgery. Curr Treat Options Cardiovasc Med 2002;4:161-9.ArticlePubMedPDF
  • 6. Qadan L, AbuRuz ME, Refaat Ahmed F, Alaloul F. Higher body mass index and prolonged cardiopulmonary bypass time increase the risk of cardiac surgery-associated acute kidney injury. Open Nurs J 2023;17.
  • 7. Kotfis K, Szylińska A, Listewnik M, Lechowicz K, Kosiorowska M, Drożdżal S, et al. Balancing intubation time with postoperative risk in cardiac surgery patients: a retrospective cohort analysis. Ther Clin Risk Manag 2018;14:2203-12.ArticlePubMedPMC
  • 8. Heringlake M, Nowak Y, Schön J, Trautmann J, Berggreen AE, Charitos EI, et al. Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients. Crit Care 2014;18:547.ArticlePubMedPMCPDF
  • 9. Sanson G, Sartori M, Dreas L, Ciraolo R, Fabiani A. Predictors of extubation failure after open-chest cardiac surgery based on routinely collected data. The importance of a shared interprofessional clinical assessment. Eur J Cardiovasc Nurs 2018;17:751-9.ArticlePubMedPDF
  • 10. Helwani MA, Copeland C, Ridley CH, Kaiser HA, De Wet CJ. A 3-hour fast-track extubation protocol for early extubation after cardiac surgery. JTCVS Open 2022;12:299-305.ArticlePubMedPMC
  • 11. Bianchi P, Constantine A, Costola G, Mele S, Shore D, Dimopoulos K, et al. Ultra-fast-track extubation in adult congenital heart surgery. J Am Heart Assoc 2021;10:e020201. ArticlePubMedPMC
  • 12. Lv Z, Cai Y, Jiang H, Yang C, Tang C, Xu H, et al. Impact of enhanced recovery after surgery or fast track surgery pathways in minimally invasive radical prostatectomy: a systematic review and meta-analysis. Transl Androl Urol 2020;9:1037-52.ArticlePubMedPMC
  • 13. Cove ME, Ying C, Taculod JM, Oon SE, Oh P, Kollengode R, et al. Multidisciplinary extubation protocol in cardiac surgical patients reduces ventilation time and length of stay in the intensive care unit. Ann Thorac Surg 2016;102:28-34.ArticlePubMed
  • 14. Wong WT, Lai VK, Chee YE, Lee A. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev 2016;9:CD003587.ArticlePubMedPMC
  • 15. Taylor M, Apparau D, Mosca R, Nwaejike N. Does early extubation after cardiac surgery lead to a reduction in intensive care unit length of stay? Interact Cardiovasc Thorac Surg 2022;34:731-4.ArticlePubMedPMCPDF
  • 16. Gumus F, Polat A, Yektas A, Totoz T, Bagci M, Erentug V, et al. Prolonged mechanical ventilation after CABG: risk factor analysis. J Cardiothorac Vasc Anesth 2015;29:52-8.ArticlePubMed
  • 17. Wiratama S, Sembiring YE, Setiawan P. Perioperative factors of fast track extubation success following coronary artery bypass graft surgery: a literature review. Bali Med J 2024;13:452-7.ArticlePDF
  • 18. Cho SJ, Stout-Delgado HW. Aging and lung disease. Annu Rev Physiol 2020;82:433-59.ArticlePubMed
  • 19. Bansal S, Thai HM, Hsu CH, Sai-Sudhakar CB, Goldman S, Rhenman BE. Fast track extubation post coronary artery bypass graft: a retrospective review of predictors of clinical outcomes. World J Cardiovasc Surg 2013;3:81-6.ArticlePDF
  • 20. Parlow JL, Ahn R, Milne B. Obesity is a risk factor for failure of "fast track" extubation following coronary artery bypass surgery. Can J Anaesth 2006;53:288-94.ArticlePubMedPDF
  • 21. Rahimi S, Abdi A, Salari N, Shohaimi S, Naghibeiranvand M. Factors associated with long-term mechanical ventilation in patients undergoing cardiovascular surgery. BMC Cardiovasc Disord 2023;23:276.ArticlePubMedPMCPDF
  • 22. Routsi C, Stanopoulos I, Kokkoris S, Sideris A, Zakynthinos S. Weaning failure of cardiovascular origin: how to suspect, detect and treat-a review of the literature. Ann Intensive Care 2019;9:6.ArticlePubMedPMCPDF
  • 23. Totonchi Z, Baazm F, Chitsazan M, Seifi S, Chitsazan M. Predictors of prolonged mechanical ventilation after open heart surgery. J Cardiovasc Thorac Res 2014;6:211-6.ArticlePubMedPMC
  • 24. Rezaianzadeh A, Maghsoudi B, Tabatabaee H, Keshavarzi S, Bagheri Z, Sajedianfard J, et al. Factors associated with extubation time in coronary artery bypass grafting patients. PeerJ 2015;3:e1414. ArticlePubMedPMCPDF
  • 25. ClinCalc LLC. Sample size calculator [Internet]. ClinCalc LLC 2024 [cited 2026 Mar 1]. Available from: https://clincalc.com/stats/samplesize.aspx
  • 26. Muller Moran HR, Maguire D, Maguire D, Kowalski S, Jacobsohn E, Mackenzie S, et al. Association of earlier extubation and postoperative delirium after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2020;159:182-90.e7.ArticlePubMed

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      Predictors of delayed extubation post–coronary artery bypass graft and its relationship with length of stay and in-hospital mortality in Jordan
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      Figure 1. Patient flow diagram.

      Figure 1.

      Predictors of delayed extubation post–coronary artery bypass graft and its relationship with length of stay and in-hospital mortality in Jordan
      Variable Total group (n=300) DE (n=75) Non-DE (n=225) P-value
      Sex ≥0.05
       Male 200 (66.7) 50 (66.7) 150 (66.7)
       Female 100 (33.3) 25 (33.3) 75 (33.3)
      Age (yr) 60±12 61±7 50±8 0.04
      Age group (yr) ≥0.05
       <40 21 (7.0) 5 (6.7) 16 (7.1)
       40–49 52 (17.3) 13 (17.3) 39 (17.3)
       50–59 97 (32.3) 24 (32.0) 73 (32.4)
       60–69 97 (32.3) 25 (33.3) 72 (32.0)
       ≥70 33 (11.0) 8 (10.7) 25 (11.1)
      Marital status ≥0.05
       Single 40 (13.3) 9 (12.0) 31 (13.8)
       Married 240 (80.0) 60 (80.0) 180 (80.0)
       Divorced/widowed 20 (6.7) 4 (5.3) 16 (7.1)
      Working status ≥0.05
       Currently working 180 (60.0) 47 (62.7) 137 (60.9)
       Not working/retired 120 (40.0) 28 (37.3) 92 (40.9)
      Smoking status ≥0.05
       Currently smoking 168 (56.0) 40 (53.3) 128 (56.9)
       Previously smoking 92 (30.7) 25 (33.3) 67 (29.8)
       Never smoked 40 (13.3) 10 (13.4) 30 (13.3)
      BMI (kg/m2) 29.61±5.43 27.5±3.6 23.9±2.3 <0.001
      BMI category (kg/m2) ≥0.05
       <28 120 (40.0) 28 (37.3) 92 (40.9)
       ≥28 180 (60.0) 47 (62.7) 133 (59.1)
      EF 50.91±7.50 37.4±6.0 40.0±4.1 <0.001
      EF Category ≥0.05
       <50% 138 (46.0) 32 (42.7) 106 (47.1)
       ≥50% 162 (54.0) 43 (57.3) 119 (52.9)
      Comorbidity
       HTN 160 (53.3) 38 (50.7) 122 (54.2) ≥0.05
       COPD 13 (4.3) 37 (49.3) 104 (46.2) ≥0.05
       DM 141 (47.0) 63(84.0) 78 (34.7) <0.001
      Previous angina 215 (71.7) 56 (74.7) 159 (70.7) ≥0.05
       Previous MI 105 (35.0) 48 (64.0) 57 (25.3) <0.001
       Heart failure 9 (3.0) 3 (4.0) 6 (2.7) ≥0.05
      Cardiopulmonary bypass time (min) 120.45±50.0 123.10±48.7 119.60±50.5 ≥0.05
      Cardiopulmonary bypass time (min) ≥0.05
       <120 194 (64.7) 46 (61.3) 148 (65.8)
       ≥120 106 (35.3) 29 (38.7) 77 (34.2)
      Aortic cross clamp time (min) 76.40±32.12 75.3±30.4 40.1±11.6 <0.001
      Operation duration (hr) 5.9±1.82 6.4±1.0 5.6±.90 0.039
      Operation duration (hr) ≥0.05
       <7 210 (70.0) 50 (66.7) 160 (71.1)
       ≥7 90 (30.0) 25 (33.3) 65 (28.9)
      Blood product transfusion ≥0.05
       PRBC 2.72±0.91 32 (42.7) 88 (39.1)
       Platelets 3.78±1.88 12 (16.0) 33 (14.7)
       FFP 1.77±1.68 18 (24.0) 42 (18.7)
       Cryoprecipitate 5.0±1.5 5 (6.7) 13 (5.8)
      Use of IABP 12 (4.0) 3 (4.0) 9 (4.0) ≥0.05
      Preoperative hemoglobin 13.1±1.8 12.9±1.7 13.2±1.8 ≥0.05
       Anemic (less than13.5 g/dl) 180 (60.0) 43 (57.3) 137 (60.9)
       Normal 120 (40.0) 32 (42.7) 88 (39.1)
      Postoperative hemoglobin 10.93±1.2 10.85±1.3 10.96±1.2 ≥0.05
       Anemic (less than13.5 g/dl) 252 (84.0) 62 (82.7) 190 (84.4)
       Normal 48 (16.0) 13 (17.3) 35 (15.6)
      Estimated glomerular filtration rate 94.1±1.9 93.8±1.8 94.2±1.9 ≥0.05
      Reintubation within 48 hr 5 (1.7) 1 (1.3) 4 (1.8) ≥0.05
      Died during hospitalization 6 (2.0) 5 (6.7) 1 (0.04) 0.021
      Variable Age BMI EF HTN MI CPB time Cross clamp time Operation time Preoperative hemoglobin
      DE 0.45a) 0.50a) –0.51a) 0.17b) 0.32a) 0.56a) 0.55a) 0.61a) –0.49a)
      Variable β Wald P-value OR 95% CI
      EF ≥50% –0.41 8.61 0.004 0.79 0.73–0.96
      Age ≥60 yr 0.56 11.62 0.003 1.71 1.03–2.91
      Operation time ≥7 hr 0.64 18.61 0.002 1.88 1.08–3.39
      CPB time ≥120 min 0.82 19.31 <0.001 2.25 1.69–3.40
      BMI ≥28 kg/m2 0.92 19.80 <0.001 2.33 1.75–3.44
      Variable Delayed extubation group (n=75) Non- delayed extubation group (n=225) P-value
      ICU LOS 7.9±1.6 3.1±1.2 <0.001
      Hospital LOS 22.6± 3.1 15.1±2.9 <0.001
      Table 1. Demographic and clinical characteristics based on extubation category

      Values are presented as number (%) or mean±standard deviation.

      DE: delayed extubation; BMI: body mass index; EF: ejection fraction; HTN: history of hypertension; COPD: history of chronic obstructive pulmonary disease; DM: diabetes mellitus; MI: myocardial infarction; PRBC: packed red blood cell; FFP: fresh frozen plasma; IABP: intra-aortic balloon pump.

      Table 2. Significant correlations between DE and demographic and clinical variables

      DE: delayed extubation; BMI: body mass index; EF: ejection fraction; HTN: hypertension; MI: myocardial infarction; CPB: cardiopulmonary bypass.

      P<0.001.

      P<0.05.

      Table 3. Independent predictors of delayed extubation by Binary logistic regression

      Variables were entered in the logistic regression as independent variables were: Block 1: age, BMI, history of hypertension, and history of myocardial infarction, Block 2: EF, CPB time, cross clamp time, operation time, and Preoperative hemoglobin.

      OR: odds ratio, EF: ejection fraction; CPB: cardiopulmonary bypass; BMI: body mass index.

      Table 4. The difference in the ICU and hospital LoS based on the DE group

      Values are presented as mean±standard deviation in days.

      ICU: intensive care unit; LoS: length of stay; DE: delayed extubation.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

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