Background: Multiple risk factors may contribute to adverse postoperative outcomes in cardiac surgery. This study sought to develop a nomogram for predicting poor recovery in cardiac surgery patients based on the patient-reported global score of the 15-item Quality of Recovery (QoR-15) scale. Methods: A retrospective study was conducted involving adult patients who underwent cardiac surgery from July 2023 to July 2024. Data collected included demographics, clinical variables, and surgical details. Poor recovery was defined as a QoR-15 score less than 118 at 24 hours post-operation. Significant predictors of poor recovery were identified through multivariate logistic regression analysis and were used to develop a nomogram. The model's performance was evaluated using the area under the curve (AUC) and calibration plots. Results: Of the 1768 patients included, the incidence of poor recovery was 27.6%. Key predictors of poor recovery included age, gender, hypertension, diabetes, operation duration, cardiopulmonary bypass duration, intraoperative blood loss, ejection fraction, and the use of dexmedetomidine administration (p < 0.05). The nomogram showed a strong discriminative capability, with an AUC of 0.795 in the training dataset and 0.734 in the testing dataset. Calibration plots indicated a high level of consistency between predicted and actual probabilities. Conclusion: The nomogram effectively predicts a QoR-15 score <118 in patients 24 hours after cardiac surgery and can be useful in forecasting poor recovery.

Opioids were considered the main analgesics for pain management during and after cardiac surgery. There are many complications associated with the use of opioids. Paravertebral block (PVB) is injecting Anaesthetics into the paravertebral space. We designed a randomised controlled trial to investigate whether PVB-based opioid-free general Anaesthesia, as compared to traditional low-dose opioid-based fast-track anaesthesia, can reduce opioid consumption within 24 h after thoracotomy incision cardiac surgery with cardiopulmonary bypass (CPB) in paediatric patients. This is a single-centre, single-blinded, randomised controlled trial with a 1:1 allocation ratio. Patients will be randomised into two groups (control group and PVB group); 20 children will be enrolled in this trial, with 10 subjects in each group. Block randomisation will be performed. Patients aged 1–6 years, with the diagnosis of atrial and/or ventricular septal deficient And scheduled for cardiac surgery via a right thoracotomic incision, will be eligible for enrolment. The primary outcome is opioid consumption during the first 24 h after surgery. The main secondary outcomes include the perioperative stress response, inflammatory level, and intraoperative haemodynamics. This is the first randomised clinical study investigating opioid-free anaesthesia based on PVB for paediatric congenital thoracotomy surgery with CPB. If the OPTION trial proves that opioid-free anaesthesia based on PVB is safe for children undergoing thoracotomic cardiac surgery, we would be glad to provide an OPTION for the perioperative management of these children, especially in the era of ERAS. Chinese Clinical Trial Registry: ChiCTR2200066517 ( www.chictr.org.cn ), Registered on December 7, 2022.

BACKGROUND:Regional anesthetic techniques are applied in cardiac surgery to improve postoperative pain and accelerate recovery. Pecto-intercostal fascial block (PIFB) combined with rectus sheath block (RSB) has been proved to provide ideal analgesia for cardiac surgery, but the effects of combing regional anesthetic techniques on postoperative recovery are uncertain. METHODS:This is a prospective and randomized controlled trial at Fuwai Hospital from 1 June 2024 to 3 July 2024. Eighty patients undergoing elective cardiac surgery via cardiopulmonary bypass were randomized at a 1:1 ratio to be allocated in the intervention group (PIFB combined with RSB) or control group (without regional blocks). The primary outcome was the global score of the 15-item quality of recovery (QoR-15) questionnaire at 24 h after surgery. Secondary outcomes included QoR-15 at 72 h, postoperative pain scores, time to extubation, length of stay, medical expenses in hospital and postoperative morbidities. RESULTS:The QoR-15 global score at 24 h after cardiac surgery was 122.35 ± 6.71 in the intervention group vs 115.30 ± 5.90 in the control group (P < .001). The proportion of patients experiencing better quality of recovery (Qor-15 ≥ 118) was higher in the intervention group (77.5% vs 55%, P = .033). Postoperative pain scores were 1.90 ± 0.18 in the intervention group compared to 2.95 ± 0.99 in the control group (P = .027) at 24 h. Time to extubation was earlier in the intervention group (274.40 ± 98.36 vs 741.28 ± 93.82 min, P < .001). There were no statistically differences in Qor-15 at 72 h and other recovery outcomes. CONCLUSION:The administration of PIFB combined with RSB could improve quality of recovery and relieve postoperative pain for patients following cardiac surgery. Key message What is already known on this topic Previous studies have demonstrated that ultrasound-guided nerve blocks effectively reduce postoperative pain in cardiac surgery patients. However, whether these techniques further enhance overall postoperative recovery remained unclear. What this study adds This trial revealed that ultrasound-guided nerve blocks improved postoperative QoR-15 scores, and combined regional techniques further improved recovery without compromising analgesia. How this study might affect research, practice, or policy The findings support applying combined nerve blocks into enhanced recovery protocols for cardiac surgery, offering evidence to optimize postoperative analgesia strategies.

Background:Previous studies have indicated that obesity can lead to an increased pain sensitivity. However, the risk of acute pain in obese patients undergoing atrial fibrillation (AF) ablation remains unclear. Methods:This was a case-control study. Clinical data of patients with AF who underwent percutaneous ablation at Fuwai Hospital between January and May 2019 were retrospectively collected. Numeric pain rating scale (NPRS) and Body mass index (BMI) were used to assess severity of intra-procedural pain and pre-procedural obesity, respectively. An intra-procedural NPRS score of 4 or higher indicated the presence of acute pain, and a pre-procedural BMI of 28 or greater was considered indicative of obesity. Multivariable logistic regression analysis was performed to explore the risk of intra-procedural acute pain in obese patients. Results:A total of 333 eligible patients were divided into two groups based on presence of intra-procedural acute pain (case group: n=102 [30.6%] and control group: n=231 [69.4%]). Compared with control group, patients with intra-procedural acute pain showed higher percentage of obesity (40 [17.4%] vs 28 [27.5%]) and conscious sedation (96 [41.6%] vs 89 [87.3%]), lower percentage of diabetes history (38 [16.5%] vs 10 [9.8%]), and longer duration of procedure (median, 90 vs 110 min). The occurrence rates of acute pain during AF ablation were 41.2% for obese patients and 27.9% for non-obese patients. Obesity was independently associated with an increased risk of intra-procedural acute pain (adjusted odds ratio [OR], 2.29; 95% CI, 1.18-4.43, P = 0.014). Sub-group analysis indicated a stronger risk of intra-procedural acute pain in obese patients under conscious sedation (adjusted OR, 2.48; 95% CI, 1.13-5.42, P = 0.023). Conclusion:Under conscious sedation, obesity is an independent risk factor for intra-procedural acute pain in adult patients undergoing AF ablation.

Perioperative dexmedetomidine is reported to reduce complications and even in-hospital mortality after cardiac surgery. We therefore tested the hypothesis that perioperative dexmedetomidine may improve long-term outcomes after cardiac surgery. This was long-term follow-up of a randomized trial. We enrolled 285 patients aged 60 years or older who were scheduled for elective cardiac surgery. Patients were randomized to receive either dexmedetomidine or placebo (normal saline) during and early after surgery. Follow-up was conducted for up to 6 years post-surgery. The primary endpoint was overall survival. Secondary outcomes included major adverse cardiovascular events (MACE)-free and hospital-free survivals, as well as cognitive function and quality of life in 6-year survivors. All 285 patients were included in final analysis. Median follow-up duration was 80 months (interquartile range 30 to 80). Overall survival did not differ between the two groups: there were 18 deaths (12.6

Compared to non-cardiac surgical patients, those undergoing cardiac surgery exhibit a higher prevalence of sleep disturbances and delirium, yet limited research has specifically examined this association in the cardiac surgical population. This study investigates the association between sleep disorders and the risk of delirium in patients after cardiac surgery, aiming to raise public awareness of the relationship. This retrospective cohort study utilized data from the MIMIC-IV database. Patients were stratified by sleep disorder status. The primary outcome was delirium incidence, and the secondary outcome was the length of stay in ICU and hospital, and all-cause mortality. The propensity score matching (PSM) was performed to adjust for the baseline imbalances. Multivariate logistic regression analysis was used to evaluate the effect of sleep disorders on delirium. Survival outcomes were analyzed using Kaplan-Meier curves with log-rank tests and Cox proportional hazards models. This study initially enrolled 6080 patients. After 1:3 matching, the final cohort consisted of 4188 patients, with 1047 assigned to the sleep disorder group and 3141 to the non-sleep disorder group. Sleep disorder was not a risk factor for postoperative delirium in either the primary cohort (odds ratio [OR]: 1.06, 95

OBJECTIVE:There is a paucity of literature regarding the application of nonintubated anesthesia in pediatric thoracoscopic surgery. This study provides a systematic description of the authors' anesthetic regimen and evaluates the feasibility and safety of nonintubated anesthesia in pediatric video-assisted thoracoscopic surgery. DESIGN:A retrospective observational study. SETTING:Operating room in a tertiary teaching hospital. PARTICIPANTS:Ninety-two pediatric patients underwent thoracoscopic surgery. INTERVENTIONS:Patients received either general anesthesia with endotracheal intubation or nonintubated general anesthesia. MEASUREMENTS AND MAIN RESULTS:Data from patients who underwent thoracoscopic surgery with nonintubated anesthesia from April 2024 to April 2025 was retrospectively reviewed. The anesthetic procedure was systematically documented. The primary outcome measure was the conversion rate from laryngeal mask airway to endotracheal intubation. Secondary outcomes of interest encompassed comprehensive perioperative safety assessments and complication parameters. A total of 94 patients were identified, with 92 meeting inclusion criteria for final analysis. The cohort comprised patients with the following primary diagnoses: pulmonary sequestration (n = 24), congenital cystic adenomatoid malformation (n = 19), mediastinal mass (n = 26), and pectus excavatum (n = 23). The conversion rate from laryngeal mask airway to endotracheal intubation was 2.1% (2/94). Secondary outcomes demonstrated clinically acceptable results across multiple parameters, including intraoperative surgical field view, vital signs, postoperative pain score, and incidence of nausea and vomiting. Furthermore, comparative analysis with historical data suggested potential benefits of nonintubated anesthesia, including reduced extubation time, decreased incidence of postoperative pulmonary complications, and shorter duration of postoperative hospital stay. CONCLUSION:Nonintubated anesthesia demonstrates both feasibility and safety in pediatric thoracoscopic surgery, representing a valuable addition to contemporary anesthetic practice. However, further prospective, multicenter trials with larger sample sizes are warranted to validate these preliminary findings.

Patients with chronic kidney disease (CKD) often encounter cardiovascular complications, most commonly coronary heart disease. Although coronary artery bypass grafting is an effective treatment for this condition, many patients experience cognitive dysfunction after cardiac surgery. The complex interactions among functional status, general anesthesia, cardiopulmonary bypass, and surgical trauma in patients with CKD elevate the risk of neurological issues and increase the mortality rates after surgery. Consequently, both quality of life and overall prognosis are significantly affected. By reviewing recent research on postoperative cognitive dysfunction in patients with CKD, we sought to clarify the underlying mechanisms affecting this population and gain theoretical insights to help decrease perioperative CKD occurrence.

OBJECTIVE:Previous studies have demonstrated that preoperative oral carbohydrates (CHO) can alleviate postoperative insulin resistance (IR) and enhance recovery in non-diabetic patients undergoing cardiac surgery. However, the potential benefits in diabetic patients remain unclear. This study aimed to investigate the effects of preoperative CHO on IR and postoperative recovery in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB). DESIGN:A prospective, single-center, single-blind, randomized controlled trial. SETTING:The study was conducted in the Adult Cardiac Surgery Ward 6 of a large-volume cardiovascular center. PARTICIPANTS:A total of 62 consecutive diabetic patients scheduled for isolated OPCAB were prospectively enrolled between July 8, 2022, and April 28, 2023. Participants were randomized in a 1:1 ratio to the CHO group or the control (CTRL) group using computer-generated random numbers. INTERVENTIONS:Patients in the CHO group received 335 mL of a carbohydrate drink containing 50 g of carbohydrates 8 to 12 hours before surgery, while those in the CTRL group followed routine fasting protocols. MEASUREMENTS AND MAIN RESULTS:The primary endpoint was postoperative IR, assessed by the homeostasis model assessment. Secondary endpoints included postoperative inflammatory markers and stress responses (e.g., serum cortisol levels), while exploratory endpoints focused on in-hospital clinical outcomes. Baseline characteristics were comparable between groups. CHO administration significantly reduced postoperative inflammatory markers but did not significantly improve IR. Stress response was attenuated in the CHO group, though the difference was not statistically significant. Postoperative drainage was higher in the CHO group, but no differences were observed in other clinical outcomes. CONCLUSION:Preoperative CHO may attenuate inflammatory and stress responses without increasing perioperative risk in diabetic patients undergoing OPCAB, although its effect IR remains uncertain.

BACKGROUND:Postoperative emergence delirium (ED), a frequent complication following general anesthesia, poses significant clinical risks including traumatic injuries and cardiorespiratory compromise. The primary objective of this study was to evaluate the effects of laryngeal mask airway versus endotracheal intubation on the incidence of ED in pediatric patients undergoing endoscopic-assisted coblation adenoidectomy. The secondary objective of this study was to evaluate and compare additional intraoperative and postoperative outcomes. METHODS:A total of 78 patients aged three - six years undergoing same-day endoscopic-assisted coblation adenoidectomy under general anesthesia were randomly allocated to either laryngeal mask airway group (Group L) or endotracheal intubation group (Group T). ED and pain were assessed using the Pediatric Anesthesia Emergence Delirium (PAED) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale, respectively. The primary outcome was the incidence of ED within 30 minutes post-extubation. The secondary outcomes included the highest FLACC score, vital signs, the duration of surgery, anesthesia time, extubation time, length of Post-Anesthesia Care Unit (PACU) stay, adverse events post-extubation, sore throat score, and the satisfaction levels of ward nurses and caregivers. RESULTS:The incidence of ED was significantly lower in Group L than in Group T (15.4% vs. 41%, P<0.05). The systolic blood pressure (106.8±14.4 mmHg vs. 122.5±17.6 mmHg), diastolic blood pressure (60.9±12.6 mmHg vs. 76.8±16.7 mmHg), and heart rate (99.8±15.4 beats/min vs. 111.4±16.6 beats/min) in Group L were significantly lower than those in Group T at post-intubation (P<0.05 for all). The extubation time (6.1±2.0 min vs. 8.6±2.1 min) and length of stay in PACU (12.5±6.1 min vs. 15.8±7.1 min) were significantly shorter in Group L compared with Group T (P<0.05 for both). The incidence of airway complications (2.6% vs. 30.8%) and hypoxemia (2.6% vs. 20.5%) were significantly lower in Group L compared to Group T after extubation (P<0.05 for both). The sore throat score at discharge was significantly lower in Group L than in Group T (0 [0 to 2] vs. 2 [0 to 4], P<0.05). Additionally, nurses' overall satisfaction was significantly higher in Group L than Group T (5 [5 to 5] vs. 5 [2 to 5], P<0.05). CONCLUSIONS:The use of laryngeal mask airway effectively reduces the incidence of ED in children undergoing same-day endoscopic-assisted coblation adenoidectomy compared to endotracheal intubation. Additionally, it provides several advantages, including shorter extubation time, attenuated hemodynamic responses to intubation stress, and reduced rates of airway complications and postoperative sore throat.

AIMS:The study aimed to determine the correlation between the maximum lactate on the first postoperative day and the incidence of postoperative delirium (POD) in patients after cardiac surgery. METHODS:The data of cardiac surgery patients were extracted from the Medical Information Mart for Intensive Care IV database. The cut-off value for the first postoperative day maximum lactate was determined, and all patients were categorized into two groups according to the cut-off value. Propensity score matching (PSM) was applied between the two groups, and the difference in the incidence of POD was analyzed. Then, we employed univariate logistic regression, multivariate logistic regression, PSM, and inverse probability of treatment weighting (IPTW) models to examine the relationship between the first postoperative day lactate levels and POD. RESULTS:Among the 4856 patients enrolled, there was a significant difference in lactate-max on the first postoperative day between patients without POD and patients with POD (median 2.5 vs. 3.1, p < 0.001). The cut-off value of lactate-max was 2.85 mmol/L. For the two groups after PSM, the incidence of POD in the lactate-max ≥ 2.85 mmol/L group was significantly elevated (19.2% vs. 15.9%, p = 0.029). The elevated lactate-max on the first postoperative day was substantially associated with an increased risk of POD in univariate and multivariate logistic regression analyses, PSM, and IPTW models. CONCLUSIONS:The results demonstrated that the first postoperative day lactate-max was correlated with the risk of POD in patients undergoing cardiac surgery, with the POD risk increasing significantly in patients with a lactate-max ≥ 2.85 mmol/L on the first postoperative day.

Background: Mounting evidence indicates that opioid-sparing anesthesia (OSA) decreases opioid-related adverse events. Our goal was to determine whether OSA might improve initial recovery after cardiac surgery. Methods: Data from patients who underwent elective heart surgery between July 2023 and July 2024 were analyzed. Eligible patients were divided into an OSA group or a control group. Patients in the OSA group received 0.5 to 1 μg·kg −1 sufentanil and ultrasound-guided nerve block after anesthetic induction, whereas patients in the control group received traditional high-dose opioid management. Patients in both groups were managed with the same sedatives, muscle relaxants, and other drugs. The main outcome was the overall 15-item Quality of Recovery (QoR-15) survey score 24 hours after surgery. Results: A total of 1916 patients were scanned, and 1218 patients were included in the analysis: 392 in the OSA group and 826 in the control group. The QoR-15 global score measured 24 hours after surgery was 119.29 ± 3.25 in the OSA group and 113.87 ± 3.44 in the control group (P < 0.001). The OSA group had lower numeric rating scale scores 24 hours and 72 hours after surgery (P < 0.001) than the control group. The median (interquartile range) postoperative mechanical ventilation time was 1.0 (0–5) hours in the OSA group and 8.0 (6–14) hours in the control group (P < 0.001), and the duration of hospitalization was 11.5 (9–14) days and 12 (10–14) days, respectively (P = 0.012). Conclusion: OSA based on ultrasound-guided nerve blocks significantly improved QoR-15 scores after cardiac surgery and is expected to be a reasonable analgesic protocol to improve the prognosis of cardiac patients.

Background: Ascending aortic diameter (AAD) is commonly measured during ultrasound examinations in cardiac surgery patients and is critical for assessing their prognosis. AAD affects renal perfusion. However, the impact of AAD on the incidence of postoperative acute kidney injury (AKI) in cardiac surgery patients remains unclear. This study aims to explore the prognostic value of AAD for postoperative AKI in adult cardiac patients. Methods: This retrospective study included patients aged ≥18 years who underwent cardiovascular surgeries from April to July 2023 at Fuwai Hospital, China. Patients were categorized into two groups: the AKI group and the non-AKI group. Preoperative cardiac ultrasound values were collected the day before surgery. The primary endpoint was the incidence of AKI. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors for postoperative AKI. The receiver operating characteristic curve was utilized to evaluate model performance. The effectiveness of including AAD in the model was also assessed. Results: The study comprised 442 patients. Both univariable and multivariable analyses indicated that AAD is an independent predictor of postoperative AKI in both on-pump and off-pump cardiac patients (p < 0.05). To control for the confounding factor of cardiopulmonary bypass (CPB) time, a subgroup analysis was conducted, which showed that including AAD improved the area under the curve (AUC) from 0.67 to 0.72 (p < 0.05) in on-pump patients. Conclusion: AAD is a significant prognostic factor for postoperative AKI in adult cardiac surgery. Its prognostic value is particularly pronounced in on-pump patients. Patients with an enlarged AAD are at a higher risk of developing AKI and experiencing adverse outcomes.

Background The ascending aortic diameter (AAD) is common in ultrasound examinations of cardiac surgery patients, and it is important for the prognosis of cardiac patients. The ascending aortic diameter has effect on renal perfusion. However, the impact of AAD on the incidence of postoperative acute kidney injury (AKI) in cardiac surgery patients is still unknown. This study aims to explore the prognostic value of ascending aortic diameter on the incidence of postoperative AKI in cardiac adult patients. Method This retrospective study included patients aged ≥18 years who underwent cardiac operations between April 2023 to July 2023 in Fuwai Hospital, China. Patients were divided into two groups: AKI group and non-AKI group. The values of cardiac ultrasound the day before surgery were collected. The end point was the rate of acute kidney injury. Univariable and multivariable logistic regression analyses were performed to identify the independent risk factors for postoperative AKI. The receiver operating characteristic curve was used to assess model performance. Using another model without AAD, the effect of the addition of AAD was assessed. Result 442 patients were included in this study. Univariable and multivariable results suggested that AAD was an independent factor of postoperative AKI for both on-pump and off-pump cardiac patients ( P <0.05). To avoid CPB time confounding factor, we went subgroup analysis of the area under the curve of CPB time further. The addition of AAD improved the area under the curve from 0.67 to 0.72 ( P <0.05) in on-pump patients. Conclusion AAD represents a prognostic value of postoperative AKI in adult cardiac surgery. The prognostic value of AAD was higher in on-pump patients.

Abstract Objective Preoperative chronic stress (CS) is associated with postoperative brain injury in patients undergoing open heart cardiac surgery. This research is to explore the potential molecular biological mechanisms of brain damage following cardiac surgery in preoperative CS rats by the analyses combining proteomics and metabolomics. Methods We constructed the chronic unpredictable stress (CUS) and cardiac surgery models in adult rats. We proved the brain injury in CUS cardiac surgery rats by Hematoxylin–Eosin (H&E) staining, followed by separating the hippocampal tissue and investigating the potential mechanisms of brain injury by the methods of data-independent acquisition proteomics and untargeted metabolomics. Results The signaling pathways of glycoproteins and metabolism of amino acids were the main possible mechanisms of brain injury in CUS rats following cardiac surgery according to the proteomics and metabolomics. In addition, the pathways of animo acids metabolism such as the pathways of lysine degradation and β-alanine metabolism may be the main mechanism of cardiac surgery related brain injury in preoperative CUS rats. Conclusions The pathways of animo acids metabolism such as lysine degradation and β-alanine metabolism may be the potential mechanisms of brain injury in CUS rats following cardiac surgery. We should focus on the varieties of bioproteins and metabolites in these pathways, and related changes in other signaling pathways induced by the two pathways.

BACKGROUND:Intra-operative urine output (UO) has been shown to predict postoperative acute kidney injury (AKI) in adults; however, its significance in children undergoing cardiac surgery remains unknown. OBJECTIVE:To explore the association between intra-operative UO and postoperative AKI in children with congenital heart disease. DESIGN:A retrospective observational study. SETTING:A tertiary hospital. PATIENTS:Children aged >28 days and <6 years who underwent cardiac surgery at Fuwai Hospital from 1 April 2022 to 30 August 2022. MAIN OUTCOME MEASURES:AKI was identified by the highest serum creatinine value within postoperative 7 days using Kidney Disease Improving Global Outcomes (KDIGO) criteria. RESULTS:In total, 1184 children were included. The incidence of AKI was 23.1% (273/1184), of which 17.7% (209/1184) were stage 1, 4.2% (50/1184) were stage 2, and others were stage 3 (1.2%, 14/1184). Intra-operative UO was calculated by dividing the total intra-operative urine volume by the duration of surgery and the actual body weight measured before surgery. There was no significant difference in median [IQR] intra-operative UO between the AKI and non-AKI groups (2.6 [1.4 to 5.4] and 2.7 [1.4 to 4.9], respectively, P  = 0.791), and multivariate logistic regression analyses showed that intra-operative UO was not associated with postoperative AKI [adjusted odds ratio (OR) 0.971; 95% confidence interval (CI), 0.930 to 1.014; P  = 0.182]. Regarding the clinical importance of severe forms of AKI, we further explored the association between intra-operative UO and postoperative moderate-to-severe AKI (adjusted OR 0.914; 95% CI, 0.838 to 0.998; P  = 0.046). CONCLUSIONS:Intra-operative UO was not associated with postoperative AKI during paediatric cardiac surgery. However, we found a significant association between UO and postoperative moderate-to-severe AKI. This suggests that reductions in intra-operative urine output below a specific threshold may be associated with postoperative renal dysfunction. TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT05489263.

Background Early extubation is a critical procedure for fast-track and enhanced recovery after surgery (ERAS) in cardiac surgery for adult patients. It might improve patients postoperative recovery. Many factors have been suggested and anesthetic management have improved, but early extubation remains a major challenge. This study aims to create a nomogram for prediction of early-extubation for cardiac surgery in adult patients. Method We reviewed medical records of 442 consecutive patients undergoing elective cardiac surgeries from April 2023 to July 2023. Factors for early extubation were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomogram was evaluated by the area under the curve (AUC) and calibration plots. Result We created nomogram of extubation within 6 hours and 8 hours. Age, pulmonary hypertension, rocuronium, operative time, and ejection fraction were identified as significantly associated factors that could be combined for accurate prediction of extubation within 6 hours. Age, pulmonary hypertension, preoperative aspartate aminotransferase (AST), rocuronium, dexmedetomidine, operative time, transfusions, and preoperative N terminal pro B type natriuretic peptide (NT-proBNP) were identified as significantly associated factors that could be combined for accurate prediction of extubation within 8 hours. We created nomogram for early extubation by using these factors. The AUC of extubation within 6 hours was 0.795 and that of extubation within 8 hours was 0.734. Conclusion The nomogram could help for prediction of early extubation in elective cardiac surgery in adult patients.

Abstract Background The remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient’s hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA). Methods We conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event. Results A total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group. Conclusion We identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.