INTRODUCTION: Early extubation following cardiac surgery is associated with decreased hospital stay and resource savings with similar mortality and has led to the widespread use of early extubation protocols. In the Vascular Quality Initiative, there is significant regional variation in the frequency of extubation in the operating room (Endovascular (EVAR): 77–97%, Open: 30–70%) following repair of intact abdominal aortic aneurysms (AAA). However, the effects extubation practices on patient outcomes after repair of AAAs are unclear. METHODS: All patients undergoing repair of an intact AAA in the Vascular Study Group of New England from 2003–2015 were evaluated. Patients undergoing concomitant procedures or conversions were excluded. Timing of extubation was stratified for EVAR (Operating Room, <12 hours, >12 hours) and open repair (Operating Room, <12 hours, 12–24 hours, >24 hours). Prolonged hospital stay was defined as >2 days following EVAR and >7 days following open repair. Univariate and multivariable analyses were completed, and independent predictors of extubation outside of the operating room were identified. RESULTS: 5774 patients were evaluated (EVAR: 4453, Open: 1321). Following both EVAR and open repair, respiratory complications, prolonged hospital stay, and discharge to a skilled nursing facility (SNF) increased with intubation time. After adjustment, the odds of complications increased with each 12-hour delay in extubation: respiratory (EVAR-OR: 4.3, 95% CI: 3.0–6.1; Open-OR: 1.8, 95% CI: 1.5–2.2), prolonged hospital stay (EVAR-OR: 2.7, 95% CI: 2.0–3.8; Open–OR: 1.3, 95% CI:1.1–1.4), and discharge to SNF (EVAR-OR: 2.0, 95% CI: 1.5–2.8; Open-1.4, 95% CI 1.1–1.6). Predictors of extubation outside of the operating room following EVAR included: increasing age (OR:1.5, 95% CI:1.2–1.8), congestive heart failure (CHF) (OR:1.9, 95% CI:1.2–3.0), chronic obstructive pulmonary disease (OR: 2.0, 95% CI: 1.4–2.9), symptomatic aneurysm (OR: 3.8, 95% CI 2.3–5.7), and increasing diameter (OR: 1.01, 95% CI: 1.01–1.01). Following open repair increasing age (OR: 1.4, 95% CI: 1.1–1.6), CHF (OR: 1.8, 95% CI: 1.01–3.3), dialysis (OR: 2.8, 95% CI: 1.7–70), symptomatic aneurysm (OR 2.8, 95% CI: 1.9–4.3), and hospital practice patterns (OR: 1.01, 95% CI: 1.01–1.01) were predictive of extubation outside of the operating room. CONCLUSIONS: The benefits of early extubation in cardiac patients are also seen following AAA repair. Suitable patients should be extubated in the operating room to decrease respiratory complications, length of stay, and discharge to SNF. Early extubation protocols should be considered to reduce regional variation in extubation practices and improve patient outcomes
