Incidence, timing, risk factors, and outcomes of unplanned reintubation after liver and pancreatic resection

Background Unplanned postoperative reintubation (UPR) may be associated with subsequent complications and increased mortality. We sought to characterize risk factors and outcomes associated with UPR after liver or pancreatic resections. Methods Adult (≥18 years old) patients who underwent elective liver or pancreatic surgery were identified in the National Surgical Quality Improvement Project Database (2014–2021). Patients requiring reintubation due to prolonged ventilatory dependence (>48 h) after surgery were excluded. Univariate and multivariable regression analyses were conducted. Results Among 85,077 patients (liver = 34,892, pancreas=50,185), 2.3 % (n = 1929) individuals required UPR with a median time to reintubation of 5 days (IQR 2–10). On multivariable regression, risk factors associated with UPR after liver resection included age ≥80 years (aOR = 4.24, 95%CI [2.81–6.38]), COPD (aOR = 1.65, 95%CI [1.17–2.34]), and total right lobectomy (aOR = 1.69, 95%CI [1.35–2.13]) while in the pancreatic surgery cohort, the risk factors included dialysis dependence (aOR = 3.99, 95%CI [2.49–6.39]), Whipple procedure (aOR = 1.64, 95%CI [1.40–1.92]), and pancreatic fistula (aOR = 2.50, 95%CI [2.11–2.97]). UPR was strongly associated with longer LOS (Liver∼+8.00 days; Pancreas∼+6.33 days), septic shock (aOR, Liver=26.33, Pancreas=5.99), and 30-day mortality (aOR, Liver=38.26; Pancreas=17.38). Conclusion UPR occurred in ∼2 % of patients after liver and pancreatic resection. Risk factors and outcomes differed by organ, but UPR consistently marked severe postoperative deterioration and was associated with substantially high mortality.