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Physician Resource

How Delaying Extubation Improves Heart Surgery Outcomes

Researchers at UVA Health recently made an important discovery that could improve outcomes for cardiac surgery patients, cutting down on reintubations and rehospitalizations.

This work comes out of UVA Health’s cardiac surgery outcomes research group, whose efforts were recognized by the American Association for Thoracic Surgery and the Society of Thoracic Surgeons.

“Here at UVA Health, we are national leaders and innovators in terms of driving the field forward,” says Nicholas Teman, MD, a cardiac surgeon, intensivist in the thoracic and cardiovascular ICU, and researcher at UVA Health who leads the research group. “The research awards we have received and the presentations that we have been selected to give are a testament to the cutting-edge nature of the research that we do. And I think that there is a lot of opportunity for growth in the future.”

Delaying Extubation for Better Outcomes

Presented at the plenary session of the 2022 American Association for Thoracic Surgery annual meeting by UVA Health researcher Andrew Hawkins, MD, the abstract Operating Room Extubation After Cardiac Surgery Is Associated With Higher Reintubation and Reoperation Due to Bleeding showed that extubating patients in the operating room after cardiac surgery carries an increased risk for bleeding, leading to reintubation and reoperation.

A safer approach, they note, is to deliver the patient to the intensive care unit while still on the ventilator, with a plan to extubate them shortly after making sure the patient is stable in the ICU. 

COVID-19: Worse Outcomes Regardless of Socioeconomic Status

During this year’s plenary session at the annual meeting of the Society of Thoracic Surgeons, UVA Health researcher Raymond Strobel, MD, presented a paper titled The COVID-19 Pandemic is Associated with Increased Cardiac Surgery Mortality, FTR, and Cost Across All Socioeconomic Statuses.

This study examined the impact of the COVID-19 pandemic on the postoperative outcomes of heart surgery patients. The findings showed that, regardless of socioeconomic status, the postoperative outcomes of all heart patients were negatively impacted by the pandemic in similar ways. This was surprising considering other research illustrating the impact of socioeconomic status on outcomes.

Both projects received recognition: an AATS Presidential Research Award and an STS Chamberlain Memorial Award.

Working With Other Virginia Hospitals

In addition to the research team at UVA Health, we also collaborate with researchers across Virginia through the Virginia Cardiac Services Quality Initiative (VCSQI). For over a decade, the VCSQI has aided the sharing of data and resources to improve patient outcomes. Their aim is to improve care quality across all cardiac care programs by fostering outcomes analysis and process improvements through the pooling of data and collaborative interpretation.  “I am proud to be the chairman of the Research and Writing Committee for the VCSQI,” Teman says.

Analyzing data from each center helps us better understand how patients fare after their cardiac surgeries, allowing us to gain a much broader and more generalizable picture of what factors impact patient outcomes. This can help inform clinical research and guide quality improvement initiatives that benefit patients across the state.

At the forefront of this collaboration is UVA Health, which has played a leading role in many of the VCSQI's initiatives. 

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