Predictors of Delayed Extubation Following Paediatric Cardiac Surgery: A Retrospective Study

Abstract

Background: Early extubation after paediatric congenital cardiac surgery is an important component of fast-track perioperative management and may reduce ventilator-associated complications, shorten intensive care unit (ICU) stay, and improve postoperative recovery. Identification of factors associated with successful early extubation may help optimize perioperative care and patient selection. Aim: To identify preoperative, intraoperative, and postoperative factors associated with early versus delayed extubation after paediatric congenital cardiac surgery. Methods: This retrospective observational study included 57 paediatric patients undergoing congenital cardiac surgery between 2023 and 2024 at Queen Alia Heart Institute (QAHI), a tertiary cardiac centre in Amman/Jordan. Patients were categorized into early extubation (including on-table extubation) and delayed extubation groups. Demographic, operative, and postoperative variables were analysed, including age, surgical complexity, cardiopulmonary bypass (CPB) duration, aortic cross-clamp time, ICU stay, and haematocrit changes. Statistical analysis was performed using independent t-tests, Mann–Whitney U tests, Chi-square tests, and Fisher’s exact tests. Results: Early extubation was achieved in 22 patients (38.6%), including 7 patients (31.8%) who underwent successful on-table extubation, while delayed extubation occurred in 35 patients (61.4%). Delayed extubation was significantly associated with younger age (newborns and neonates) (p=0.041), complex cyanotic congenital heart disease (p=0.011), prolonged CPB duration (81.4 ± 67.2 vs 43.9 ± 28.4 minutes, p=0.021), longer aortic cross-clamp time (47.2 ± 31.5 vs 24.7 ± 14.1 minutes, p=0.031), and high-complexity procedures including Tetralogy of Fallot repair, arterial switch operations, Glenn procedures, and TCPC procedures (p=0.009). Early extubation was associated with significantly shorter ICU stay (2.1 ± 1.2 vs 5.4 ± 2.8 days, p=0.004). On-table extubation was strongly associated with simple acyanotic heart lesions and successful fast-track recovery (p<0.001). Conclusion: Early extubation after paediatric congenital cardiac surgery is feasible and safe in selected patients. Low body weight was an independent predictor of delayed extubation, while lower surgical complexity and shorter cardiopulmonary bypass duration favoured successful fast-track recovery.