Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database

Am Surg. 2015 Aug;81(8):820-5.


Postoperative unplanned intubation (PUI) is a significant complication and is associated with severe adverse events and mortality. By participating in the National Surgical Quality Improvement Program (NSQIP), we learned that PUI occurred more frequently than expected at our institution. The aim of this study was to identify risk factors that are predictors of PUI at our institution. We reviewed the NSQIP data from our institution and the NSQIP national database for surgery patients from 2010 through 2013. The rate of PUI at our institution was 1.54 per cent compared with the national rate of 1.03 per cent. Perioperative risk factors were analyzed by multivariate logistic regression. Analysis of the national NSQIP database identified 14 independent risk factors for PUI. Analysis of the NSQIP data at our institution demonstrated that emergent cases, preoperative ventilator status, smoking, chronic obstructive pulmonary disease, and older age were independent risk factors. In conclusion, patients at our institution with these five risk factors were at higher risk of requiring PUI. These risk factors could be used to help identify patients at high risk and possibly help prevent postoperative respiratory failure and unplanned intubation.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Causality
  • Comorbidity
  • Confidence Intervals
  • Databases, Factual*
  • Female
  • Follow-Up Studies
  • Hospital Mortality*
  • Humans
  • Incidence
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods
  • Intubation, Intratracheal / mortality
  • Intubation, Intratracheal / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Pennsylvania / epidemiology
  • Postoperative Care / methods
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Postoperative Period
  • Predictive Value of Tests
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Surgical Procedures, Operative / adverse effects*
  • Surgical Procedures, Operative / methods
  • Survival Rate
  • Treatment Outcome