Extubation in the operating room after elective on-pump CABG surgery: impact on patient outcome and clinical practice during the COVID-19 pandemic.

Purpose: Coronary artery bypass graft (CABG) surgery is the standard treatment for advanced coronary artery disease. Despite evidence supporting enhanced recovery after surgery (ERAS) programs, many hospitals continue to keep patients intubated following on-pump CABG surgery. The coronavirus disease 2019 (COVID-19) pandemic further strained intensive care unit (ICU) capacities, leading to the consideration of immediate extubation after elective surgeries like CABG surgeries. The aim of this study was to assess whether extubation in the operating room after elective on-pump CABG surgery would reduce the ICU length of stay, the ICU readmission, and the ICU mortality in a population of patients undergoing on-pump CABG surgery as opposed to the conventional approach with patients remaining intubated.

Methods: This study is a retrospective single-center study, including data from the University Hospital Aachen, Germany. Clinical data from 2019 to 2022 were analyzed, focusing on patients who underwent on-pump CABG surgery. Primary endpoints studied were the duration of ICU stay, rates of ICU readmission, and ICU mortality. Secondary outcomes included the hospital length of stay, hospital mortality, and the occurrence of postoperative pneumonia.

Results: Ninety-seven patients who underwent elective on-pump CABG surgery were identified. There were no variations in outcomes, including ICU and hospital stays, mortality, ICU readmission, or postoperative pneumonia between the two groups.

Conclusion: Extubation in the operating room after on-pump CABG surgery did not result in significant differences in outcomes compared to patients who remained intubated.

Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-025-01908-9.