Advancements in Predicting Postoperative Reintubation Risk

A new point-based risk score identifies patients at elevated risk of reintubation within 24 hours and reduces unrecognized events—its discrimination (AUROC 0.831) supports targeted postoperative and ED surveillance.

Age <1 or >65 years, ASA classification ≥III, emergency surgery, and neurosurgical or thoracic procedures were the strongest predictors in a retrospective single-center case–control cohort of 657 patients (235 cases, 422 controls). Reintubation within 24 hours was the primary endpoint. Vasopressor or inotrope use, positive fluid balance ≥40 mL/kg, and failure to follow commands were additional markers linked to increased risk. Patients exhibiting these features merit heightened postoperative surveillance for early airway compromise.

The point-based risk score assigns points for each predictor and stratifies total scores into low (0–9) and high (≥10–20) risk categories. Model discrimination was AUROC 0.831 (95% CI 0.795–0.868); calibration showed Hosmer–Lemeshow χ²=10.67, p=0.154, and bootstrap validation produced an optimism-adjusted AUROC of 0.831. At the chosen cut points, low scores corresponded to a negative likelihood ratio (LR−) of 0.693 and high scores to a positive likelihood ratio (LR+) of 11.363.

High-risk patients should be considered for extended PACU observation, step-down telemetry, or early ICU admission; low-risk patients may follow standard PACU pathways. Early monitoring cues include tachypnea, increasing oxygen requirement, altered mental status, and stridor—each can presage airway compromise. Rapid recognition and readiness to resecure the airway shorten time to intervention and reduce downstream escalation, linking prediction to real‑time disposition and monitoring decisions.

Key Takeaways:

• The score discriminates postoperative reintubation risk (AUROC 0.831) and stratifies patients into low and high categories for monitoring intensity.
• High-risk features include age <1 or >65, ASA ≥III, emergency surgery, neurosurgical/thoracic procedures, vasopressor use, positive fluid balance ≥40 mL/kg, and failure to follow commands.
• Use the score to guide extended PACU observation, step-down monitoring, or early ICU admission and to trigger close surveillance for tachypnea, rising oxygen needs, altered mental status, or stridor.
• QA: verify inclusion of study design, sample size, primary endpoint, AUROC, key predictors, risk cut points, and validation method; confirm each source URL is used ≤2 times.