Factors Associated With Late Extubation in Postoperative Patients in the Surgical Intensive Care Unit

The Related Factors of Post Operation Patients With Late Extubation in Surgical Intensive Care Unit

Timely removal of a breathing tube after surgery is an important part of recovery for patients admitted to the intensive care unit (ICU). In some cases, patients may require longer use of mechanical ventilation, which can be associated with longer hospital stays and a higher risk of complications.

The purpose of this study is to examine clinical factors that may be associated with delayed removal of breathing tubes in postoperative ICU patients. This study will use information that has already been routinely collected during standard medical care, such as patient characteristics, breathing-related measurements, fluid balance, and laboratory test results.

This is a retrospective observational study and does not involve any additional treatments, procedures, or changes to routine clinical care. By analyzing these existing data, the study aims to improve understanding of factors related to extubation timing and support future efforts to enhance postoperative ICU care.

Study Overview

• Status: Completed
• Conditions: Mechanical Ventilation Weaning; Delayed Extubation; Postoperative Intensive Care
• Intervention / Treatment: Other: No Intervention - Retrospective Observational Study

Detailed Description

Delayed extubation after surgery is a common clinical challenge in postoperative intensive care unit (ICU) patients and is associated with increased risks of pulmonary complications, prolonged mechanical ventilation, and extended hospitalization. Determining optimal extubation timing remains complex because respiratory mechanics, metabolic status, neurologic recovery, and perioperative stress responses must align for successful ventilator liberation.

This study is a retrospective observational study designed to identify clinical factors associated with delayed extubation in postoperative ICU patients and to develop predictive models using routinely collected clinical data. The institutional cohort includes adult postoperative patients admitted to the surgical ICU at Kaohsiung Armed Forces General Hospital who required invasive mechanical ventilation. An external cohort derived from the MIMIC-IV database is used to support model development and cross-domain learning. No additional interventions, procedures, or changes to standard clinical care are involved.

Delayed extubation is defined as removal of the endotracheal tube more than 24 hours after initiation of mechanical ventilation, while early extubation is defined as extubation within 24 hours. Demographic characteristics, disease severity scores, respiratory parameters, perioperative laboratory data, and fluid balance variables routinely documented in medical records are included for analysis.

Statistical analyses include univariable and multivariable regression models to identify factors independently associated with delayed extubation and hospital length of stay. In addition, machine learning and deep learning approaches are applied to explore complex interactions among clinical variables and to improve prediction performance. Transfer learning techniques are used to enhance model generalizability by integrating information from external ICU datasets while adapting to local institutional data.

The primary objective of this study is to improve understanding of physiologic, metabolic, and respiratory determinants of delayed extubation in postoperative ICU patients. The findings may support more individualized ventilator weaning strategies, reduce prolonged mechanical ventilation, and improve postoperative ICU care. This study involves secondary analysis of existing clinical data and poses no additional risk to patients.

• Study Type: Observational
• Enrollment (Actual): 204

Contacts and Locations

Study Locations

• Taiwan
  • 永康區
    • Kaohsiung City, 永康區, Taiwan, 802
      • Kaohsiung Armed Forces General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult postoperative patients admitted to the surgical intensive care unit who required invasive mechanical ventilation as part of routine postoperative care. This retrospective observational study analyzes existing clinical data collected during standard medical practice. No additional interventions, procedures, or changes to patient management were involved.

Description

Inclusion Criteria:

1. Postoperative patients admitted to the surgical intensive care unit.
2. Patients who required invasive mechanical ventilation after surgery.
3. Patients with documented intubation and extubation events during the ICU stay.
4. Patients with available routine clinical data, including demographic information, respiratory parameters, and laboratory results.

Exclusion Criteria:

1. Patients without documented extubation information.
2. Patients admitted to non-surgical intensive care units.
3. Patients with incomplete or missing key clinical data required for analysis.
4. Patients who did not receive invasive mechanical ventilation.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Early Extubation Group; This cohort includes postoperative intensive care unit patients who were extubated within 24 hours after initiation of invasive mechanical ventilation. No interventions were assigned as part of this study. Clinical data were analyzed retrospectively.	Other: No Intervention - Retrospective Observational Study; No intervention was administered or assigned in this study. This is a retrospective observational study based on secondary analysis of existing clinical data collected during routine clinical care. No changes to patient management, treatment decisions, or standard care were made as part of this study.
Delayed Extubation Group; This cohort includes postoperative intensive care unit patients who were extubated more than 24 hours after initiation of invasive mechanical ventilation. No interventions were assigned as part of this study. Clinical data were analyzed retrospectively.	Other: No Intervention - Retrospective Observational Study; No intervention was administered or assigned in this study. This is a retrospective observational study based on secondary analysis of existing clinical data collected during routine clinical care. No changes to patient management, treatment decisions, or standard care were made as part of this study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Delayed Extubation	Delayed extubation is defined as removal of the endotracheal tube more than 24 hours after initiation of invasive mechanical ventilation during postoperative intensive care unit admission.	Within 24 hours to 30 days after initiation of invasive mechanical ventilation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital Length of Stay	Hospital length of stay is defined as the total number of days from hospital admission to hospital discharge.	From hospital admission through hospital discharge, up to 30 days
Duration of Mechanical Ventilation	Duration of mechanical ventilation is defined as the time from initiation of invasive mechanical ventilation to successful extubation.	From initiation of invasive mechanical ventilation to extubation, up to 30 days

Collaborators and Investigators

• Sponsor: Kaohsiung Armed Forces General Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2019
• Primary Completion (Actual): November 30, 2019
• Study Completion (Actual): December 31, 2019

Study Registration Dates

• First Submitted: April 20, 2026
• First Submitted That Met QC Criteria: June 18, 2026
• First Posted (Actual): June 22, 2026

Study Record Updates

• Last Update Posted (Actual): June 22, 2026
• Last Update Submitted That Met QC Criteria: June 18, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative care; Weaning; Mechanical ventilation; Machine learning; Rapid shallow breathing index; serum calcium; Surgical intensive care unit; Delayed extubation; cumulative fluid balance; weaning predictors
• Other Study ID Numbers: KAFGHIRB 108-006

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because this is a retrospective observational study based on institutional clinical records. Data access is restricted by institutional policies and ethical approvals, and no consent for data sharing outside the study team was obtained.