Early Extubation and Postoperative Complications After Liver Transplantation

Study Overview
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Brief Summary
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This is a retrospective cohort study. Patients who underwent liver transplantation from January 1, 2016 to December 31, 2019 were admitted to the study and divided into two groups. Operating room extubation group: early extubation in the operating room immediately following liver transplantation. Intensive care unit (ICU) extubation group: delay extubation in the ICU following liver transplantation. The primary objectives were to compare the incidence of composite outcome between the two groups. secondary objectives were to compare outcomes such as length of stay, hospital length of stay, and total cost between the two groups.

Detailed Description
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Patients who underwent liver transplantation from January 1, 2016 to December 31, 2019 were admitted to the study. Inclusion criteria: (1) adult patients (age ≥ 18 years), (2) undergoing liver transplantation. Exclusion criteria were the following: (1) re-transplantation; (2) multi-visceral transplantation; (3) intraoperative death; (4) severe encephalopathy (West Haven criteria III or IV); (5) those who had preoperative mechanical ventilation; (6) incomplete clinical data. The primary objectives was a composite of 30-day all-cause mortality, in-hospital AKI, or in-hospital moderate to severe pulmonary complications. Complications were defined and graded as mild, moderate, or severe as described by European Perioperative Clinical Outcome definitions and were included if they occurred in hospital after surgery. The secondary objectives included in-hospital moderate to severe infectious complications, unplanned reintubation rates, ICU and postoperative hospital lengths of stay, and total hospital cost.

Official Title
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Association Between Early Extubation and Postoperative Complications After Liver Transplantation: A Retrospective Propensity Score-matched Analysis

Conditions
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Liver Transplantation

Intervention / Treatment
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* Procedure: extubation in the operating room
* Procedure: extubation in the ICU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients (age ≥ 18 years) Undergoing liver transplantation Exclusion Criteria: Re-transplantation Multi-organ transplants Intra-operative deaths severe encephalopathy (West Haven criteria III or IV) patients who had preoperative mechanical ventilation or fulminant hepatic failure Incomplete clinical data

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Operating room extubation group<br>extubation in the operating room immediately following liver transplantation | Procedure: extubation in the operating room<br>* Patients who underwent liver transplantation early extubation in the operating room immediately following liver transplantation<br>|
| ICU extubation group<br>extubation in the ICU following liver transplantation | Procedure: extubation in the ICU<br>* Patients who underwent liver transplantation extubation in the ICU following liver transplantation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of a composite of 30-day all-cause mortality, AKI and moderate to severe pulmonary complications. | Complications were defined and graded as mild, moderate, or severe as described by European Perioperative Clinical Outcome definitions and were included if they occurred in hospital after surgery | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of moderate to severe infectious complications | Complications were defined and graded as mild, moderate, or severe as described by European Perioperative Clinical Outcome definitions and were included if they occurred in hospital after surgery | 30 days | 
| The incidence of re-intubation. | Reintubation was defined as intubation after extubation of a patient who had been initially tracheal intubated under general anaesthesia | 30 days | 
| The length of hospital stay | Length of hospital stay is the duration of a single episode of hospitalization | through study completion, an average of 1 year | 
| The length of ICU stay | Length of ICU stay is the duration of a single episode of ICU hospitalization | through study completion, an average of 1 year | 
| The total hospital cost | The total hospital cost | 30 days |