Comparison of Hospital Stay between On Table Extubation Versus ICU Extubation in Off-Pump CABG

Authors

  • Zamain Tariq
  • Gul E Zaahra Mahmood
  • Ahsan Amjad
  • Tavyamn Tahseen
  • Samreen Gul
  • Syed Imran Ul Hassan

Keywords:

CABG, early extubation, hospital stay, ICU stay, on-table extubation, outcomes, stratification

Abstract

Background: Early extubation following off-pump coronary artery bypass grafting (CABG) has been suggested to reduce complications and shorten hospital stay. However, the safety and efficacy of on-table extubation compared to intensive care unit (ICU) extubation remain debated.

Objectives: To compare early outcomes between on-table extubation and ICU extubation in patients undergoing off-pump CABG.

Study Design & Setting: A study conducted at Department of Anesthesia, Punjab Institute of Cardiology, Lahore from 27 May 2025 to 27 September 2025

Methodology: A total of 248 patients undergoing elective off-pump CABG were included and divided into two groups: Group A (n = 124) underwent on-table extubation, while Group B (n = 124) underwent ICU extubation. Baseline characteristics, intraoperative variables, and postoperative outcomes were recorded. Stratification was performed for age, gender, diabetes mellitus, hypertension, and hospital stay to control for confounders. Data were analyzed using SPSS version 25.0, with p ≤ 0.05 considered statistically significant.

Results: Both groups were comparable in terms of baseline demographics, risk factors, and intraoperative parameters (p > 0.05). The mean ICU stay was significantly shorter in Group A (1.4 ± 0.6 days) compared to Group B (2.6 ± 0.9 days, p < 0.001). Hospital stay was also reduced in Group A (5.8 ± 1.4 days vs. 7.1 ± 1.6 days, p = 0.061), with a higher proportion discharged within 7 days (76.6% vs. 62.9%, p = 0.021). Stratification analysis showed consistently shorter hospital stays across subgroups of age, gender, diabetes, and hypertension in Group A.

Conclusion: On-table extubation after off-pump CABG is a safe and effective strategy associated with shorter ICU and hospital stays without increasing perioperative risks

Downloads

Download data is not yet available.

References

Wong WT, Lai VK, Chee YE, Lee A. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev 2016;2016(9):CD003587.

Milic ZW, Debesa O, Ohkuma H, Duquaine D, Steppan J, Schneider HB, Whitman CJ. A protocol-driven approach to early extubation after heart surgery. J Thorac Cardiovasc Surg 2014;147(4):1344-1349.

Grant MC, Isada T, Ruzankin P, Whitman C, Lawton JS, Dodd-o J, Barodka V, Ibekwe S, Mihocsa AL, Gottschalk A, Liu C. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg 2020;159(4):1391-1402.

Shahian DM, Jacobs JP, Badhwar V, Kurlansky PA, Furnary AP, Cleveland JC Jr, Lobdell KW, Vassileva C, von Ballmoos MC, Thourani VH, Rankin JS. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: part I background, design considerations, and model development. Ann Thorac Surg 2018;105(5):1411-1418.

Straka Z, Brucek P, Vanek T, Votava J, Widimsky P. Routine immediate extubation for off-pump coronary artery bypass grafting without thoracic epidural analgesia. Ann Thorac Surg 2002;74(5):1544-1547.

Chamchad D, Horrow JC, Nakhamchik L, Sutter FP, Samuels LE, Trace CL, Ferdinand F, Goldman SM. The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay. J Cardiothorac Vasc Anesth 2010;24(5):780-784.

Badhwar V, Esper S, Brooks M, Mulukutla S, Hardison R, Mallios D, Chu D, Wei L, Subramaniam K. Extubating in the operating room after adult cardiac surgery safely improves outcomes and lowers costs. J Thorac Cardiovasc Surg 2014;148(6):3101-3109.

James L, Smith DB, Calloway AC, Paone D, Allison M, Shrivastava S, Vaynblat M, Swistel DC, Loulmet DF, Grossi EA, Williams MR. Routine extubation in the operating room after isolated coronary artery bypass. Ann Thorac Surg 2024;117(1):87-94.

Silva E, Borgomoni OB, Maia AD, do Vale Junior CF, Pereira ED, Silvestre LO, de Andrade DP, Lisboa LA, Joaquim FB, Moita O, REPLICCAR Study Group. Extubation in the operating room after coronary artery bypass graft surgery reduces hospital stay. J Cardiothorac Vasc Anesth 2023;37(10):1935-1945.

Doenst T, Thiele H, Haasenritter J, Wahlers T, Massberg S, Haverich A. The treatment of coronary artery disease: Current status six decades after the first bypass operation. Deutsches Ärzteblatt International. 2022 Oct 21;119(42):716.

Hayanga HK, Ellison MB, Badhwar V. Patients should be extubated in the operating room after routine cardiac surgery: an inconvenient truth. JTCVS techniques. 2021 Aug 1;8:95-9.

Nagre AS, Jambures NP. Comparison of immediate extubation versus ultrafast tracking strategy in the management of off-pump coronary artery bypass surgery. Annals of cardiac anaesthesia. 2018 Apr 1;21(2):129-33.

Hussain G, Azam H, Baig MA, Ahmad N. Early outcomes of on-pump versus off-pump Coronary Artery Bypass Grafting. Pakistan Journal of Medical Sciences. 2016 Jul;32(4):917.

Ibrahim RZ, Joyo EO. Intensive care unit length of stay and mortality comparison between on-pump and off-pump coronary artery bypass graft: a retrospective study. The Egyptian Heart Journal. 2023 Jun 12;75(1):48.

Parizad R, TABAN SM, GASEMIAN KZ. Comparison of Duration of Intubation in Coronary Artery Bypass Graft Surgery With On-Pump and Off-Pump. Crescent Journal of Medical and Biological Sciences.2020;3(2):54-57.

Khan MG, Khan A, Khan I, Khan S, Shah H, Khan HA. Effect of on-Pump and Off-Pump Coronary Artery Bypass Graft on Length of Icu Stay among Low Ejection Fraction Patients Going through Cardiac Revascularization. Journal of Health and Rehabilitation Research. 2024 Mar 21;4(1):1484-9.

Hawkins AD, Strobel RJ, Mehaffey JH, Hawkins RB, Rotar EP, Young AM, Yarboro LT, Yount K, Ailawadi G, Joseph M, Quader M. Operating room versus intensive care unit extubation within 6 hours after on-pump cardiac surgery: early results and hospital costs. InSeminars in thoracic and cardiovascular surgery 2024 Jun 1 (Vol. 36, No. 2, pp. 195-208). WB Saunders.

Soliman F, Pepe R, Chao J, Telenson S, Pantin E, Takebe M, et al. On-Table versus Early Extubation after Coronary Bypass: Earlier Discharge with Equivalent Outcomes [presentation]. 103rd Annual Meeting of the American Association for Thoracic Surgery; 2023 May 7; Los Angeles, CA, USA. Available from: https://www.aats.org/resources/on-table-versus-early-extubation-after-coronary-bypass-earlier-discharge-with-equivalent-outcomes

Siddique ABM, Taher A, Moral MS, Ahmed MS, Alam MH, Harun-Ur-Rashid M. Hemodynamic changes during off-pump versus onpump cardiac surgeries. Int J Adv Med 2025;12:160-5.

Hossain MA, Saha SK, Mittal M. On-Table Extubation After Off-Pump Coronary Artery Bypass: A Step Forward to Fast-Track Recovery. Cureus. 2025 Jun 20;17(6)..

Downloads

Published

2025-11-04

How to Cite

1.
Tariq Z, Mahmood GEZ, Amjad A, Tahseen T, Gul S, Ul Hassan SI. Comparison of Hospital Stay between On Table Extubation Versus ICU Extubation in Off-Pump CABG. J Neonatal Surg [Internet]. 2025 Nov. 4 [cited 2026 Apr. 14];14(32S):9356-62. Available from: https://jneonatalsurg.com/index.php/jns/article/view/9484

Issue

Vol. 14 No. 32S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.