Extubation in the Operating Room After Transapical Transcatheter Aortic Valve Implantation Safely Improves Time-Related Outcomes and Lowers Costs: A Propensity Score-Matched Analysis

Objective: The experience of safe extubation in the operating room (OR) after transcatheter aortic valve implantation (TAVI) procedure remains not well established. The authors conducted this study to assess the effect of OR extubation in comparison with extubation in the intensive care unit (ICU) on the outcomes and cost in patients undergoing transapical-TAVI.Design: A propensity score-matched analysis.Setting: A single major urban teaching and university hospital.Participants: A total of 266 patients undergoing transapical TAVI under general anesthesia between June 2015 and March 2020.Interventions: Propensity matching on pre- and intraoperative variables was used to identify 99 patients undergoing extubation in the OR versus 72 undergoing extubation in the ICU for outcome analysis.Measurements and main results: After matching, extubation in the OR showed significant reductions of length of stay (LOS) in ICU (38.8 +/- 17.4 v 58.0 +/- 70.0 h, difference -19.2, 95% confidence interval [CI] -35.7 to -2.7, p = 0.009) and postoperative LOS in hospital (7.1 +/- 3.9 v 10.1 +/- 4.6 d, difference -3.0, 95% CI -4.3 to -1.7, p < 0.0001) compared with ICU extubation, but did not significantly affect the composite incidence of any postoperative complications (46.5% [46 of 99] v 52.8% [38 of 72], difference -6.3%, 95% CI -21.5 to 8.9, p = 0.415). Also, extubation in the OR led to significant reduction of total hospital cost compared with extubation in the ICU ((SIC)303.5 +/- 17.3 v (SIC)329.9 +/- 52.3 thousand, difference -26.2, 95% CI -38.8 to -13.7, p < 0.0001).Conclusions: The current study provided evidence that extubation in the OR could be performed safely without increases in morbidity, mortality, or reintubation rate and could provide cost-effective outcome benefits in patients undergoing transapical-TAVI. (C) 2020 Elsevier Inc. All rights reserved.