Early Extubation After Minimally Invasive Coronary Artery Bypass Grafting: Perioperative Predictors and Clinical Outcomes

Objectives: This study aimed to identify perioperative predictors of early extubation and to evaluate its impact on postoperative outcomes in patients undergoing minimally invasive coronary artery bypass grafting (MICS-CABG).
Methods: This single-center retrospective cohort study included 95 adult patients who underwent isolated MICS-CABG between January 2021 and January 2024. Patients were categorized according to extubation time as early (≤6 hours, n=60) or late (>6 hours, n=35). Standard perioperative care was applied to all patients, and an early extubation protocol was implemented in eligible cases.
Results: Patients in the early extubation group were younger (58 vs. 67 years, p=0.0002), had higher ejection fractions (55% vs. 45%, p<0.001), and lower EuroSCORE II values (1.3% vs. 3.36%, p<0.001). Intraoperative blood transfusion (p=0.0001) and inotrope use (p=0.031) were more frequent in the late extubation group. Postoperative pneumonia (p=0.016) and arrhythmia (p=0.029) rates were also significantly higher among patients with delayed extubation. In multivariate analysis, EuroSCORE II (OR 0.20, 95% CI 0.08–0.51, p=0.0008), blood transfusion (OR 0.23, 95% CI 0.08–0.66, p=0.006), and inotrope use (OR 0.31, 95% CI 0.11–0.90, p=0.031) were identified as independent predictors. ROC analysis confirmed excellent discriminative ability of the model (AUC=0.95).
Conclusion: Early extubation following MICS-CABG is a safe and feasible approach in appropriately selected patients. EuroSCORE II was identified as the strongest predictor, while blood transfusion and inotrope use were associated with delayed extubation. These findings support structured risk assessment and intraoperative optimization as essential components of fast-track recovery protocols.

Keywords: Early extubation, fast-track recovery protocols, minimally ýnvasive coronary artery bypass, predictors of perioperative outcomes