Mohamad El Moheb, Zeyad T Sahli, Badi Rawashdeh, Paola Vargas, Shawn Pelletier, Jose Oberholzer, Katherine T Forkin, Eryn Thiele, Julie Huffmyer, David Bogdonoff, Stephen Collins, Amanda Kleiman, Nicolas Goldaracena
{"title":"Fast-Track Score to Predict the Feasibility of Early Extubation Post Liver Transplant.","authors":"Mohamad El Moheb, Zeyad T Sahli, Badi Rawashdeh, Paola Vargas, Shawn Pelletier, Jose Oberholzer, Katherine T Forkin, Eryn Thiele, Julie Huffmyer, David Bogdonoff, Stephen Collins, Amanda Kleiman, Nicolas Goldaracena","doi":"10.1177/00031348241286073","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Over the past several years, the liver transplant community has embraced the concept of fast-tracking patients to facilitate earlier postoperative recovery.</p><p><strong>Aim: </strong>Derive and validate a novel \"fast-track\" risk score that captures the demographic and clinical characteristics of DDLT patients to predict the likelihood of early extubation after surgery.</p><p><strong>Design: </strong>Adult patients who underwent non-fulminant DDLT between January 2014 and July 2019 were included. The cohort was divided in 2 groups: patients extubated within 4 hours of surgery vs extubated after 4 h. Logistic regression was performed to identify the independent predictors of early extubation. The area under the curve (AUC) was calculated to measure the ability of the risk score to predict early extubation. The score was validated by applying coefficients of the regression model to the validation cohort and calculating the AUC.</p><p><strong>Results: </strong>A total of 290 DDLT patients were included, of which 175 (60%) were in the \"delayed extubation\" group and 115 (40%) were in the \"fast-track\" group. Patients with a MELD <29, transfused <4 units of pRBCs, and transfused <5 units of FFP during surgery were 2.30 times, 5.74 times, and 3.09 times more likely to be extubated early, respectively. A risk score with an integer point scale was derived and exhibited an AUC of .80. The proportion of patients who were extubated early increased from 2.78% at a score of 0 to 66.67% at a score of 4.</p><p><strong>Conclusions: </strong>The proposed score provides a fast and easy method to help identify DDLT patients suitable for early extubation.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":"91 2","pages":"217-223"},"PeriodicalIF":1.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Surgeon","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/00031348241286073","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Fast-Track Score to Predict the Feasibility of Early Extubation Post Liver Transplant.
Background: Over the past several years, the liver transplant community has embraced the concept of fast-tracking patients to facilitate earlier postoperative recovery.
Aim: Derive and validate a novel "fast-track" risk score that captures the demographic and clinical characteristics of DDLT patients to predict the likelihood of early extubation after surgery.
Design: Adult patients who underwent non-fulminant DDLT between January 2014 and July 2019 were included. The cohort was divided in 2 groups: patients extubated within 4 hours of surgery vs extubated after 4 h. Logistic regression was performed to identify the independent predictors of early extubation. The area under the curve (AUC) was calculated to measure the ability of the risk score to predict early extubation. The score was validated by applying coefficients of the regression model to the validation cohort and calculating the AUC.
Results: A total of 290 DDLT patients were included, of which 175 (60%) were in the "delayed extubation" group and 115 (40%) were in the "fast-track" group. Patients with a MELD <29, transfused <4 units of pRBCs, and transfused <5 units of FFP during surgery were 2.30 times, 5.74 times, and 3.09 times more likely to be extubated early, respectively. A risk score with an integer point scale was derived and exhibited an AUC of .80. The proportion of patients who were extubated early increased from 2.78% at a score of 0 to 66.67% at a score of 4.
Conclusions: The proposed score provides a fast and easy method to help identify DDLT patients suitable for early extubation.
期刊介绍：
The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.
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