Variation in tracheal reintubations among patients undergoing cardiac surgery across Washington state hospitals

Abstract

Objectives: The objectives of this study were to examine the variation in reintubations across Washington state hospitals that perform cardiac surgery, and explore hospital and patient characteristics associated with variation in reintubation.

Design: Retrospective cohort study.

Setting: All nonfederal hospitals performing cardiac surgery in Washington state.

Participants: A total of 15,103 patients undergoing coronary artery bypass grafting or valvular surgery between January 1, 2008 and September 30, 2011.

Interventions: None.

Measurements and main results: Patient and hospital characteristics were compared between hospitals that had a reintubation frequency ≥5% or<5%. Multivariate logistic regression was used to compare the odds of reintubation across the hospitals. The authors tested for heterogeneity of odds of reintubation across hospitals by performing a likelihood ratio test on the hospital factor. After adjusting for patient-level characteristics and procedure type, significant heterogeneity in reintubations across hospitals was present (p = 0.005). This exploratory analyses suggested that hospitals with lower reintubations were more likely to have more acute care days and teaching intensive care units (ICU).

Conclusions: After accounting for patient and procedure characteristics, significant heterogeneity in the relative odds of requiring reintubation was present across 16 nonfederal hospitals performing cardiac surgery in Washington state. The findings suggested that greater hospital volume and ICU teaching status were associated with fewer reintubations.

Keywords: cardiac surgery; critical care; extubation failure; outcomes; reintubation.

Copyright © 2015 Elsevier Inc. All rights reserved.

Figures

Figure 1. Funnel plot

The funnel plot shows the estimated proportion of reintubations at each hospital (dots). The average proportion across all hospitals (4.4%) is shown by the solid line. The dashed and dotted lines provide confidence intervals for the test of whether each hospital is significantly worse than average at the 0.05 and 0.01 level of significance, respectively. Thus, if a dot falls above/below the dashed/dotted confidence bands, we may conclude that the proportion of patients reintubated at that hospital is significantly higher/lower than average at a 0.05/0.01 level of significance. Dots: Estimated proportion of reintubations at each hospital; Solid line: Average proportion of patients reintubated across all hospitals; Dashed line: 95% confidence band for average proportion of patients reintubated across all hospitals; Dotted line: 97.5% confidence band for average proportion of patients reintubated across all hospitals

Figure 2

Adjusted odds ratios (and 95% confidence intervals) of reintubation in cardiac surgery patients (N=14,957) across the 16 Washington State hospitals.