Résumé
Airway control and especially extubation are important issues after surgery. Abdominal surgery is at risk of atelectases and postoperative hypoxemia. The recent COVID-19 pandemic has led some institutions to change their practice, by favoring extubation in the operating room instead of in the recovery room. However, to date no study has compared the rate of complications of extubation according to the place of extubation after abdominal surgery. The main hypothesis of this study was that the rate of post-extubation hypoxemia would be decreased after extubation in the operating room when compared with extubation in the recovery room, after abdominal surgery. Methods: in this prospective observational study, patients were included after abdominal surgery in the University Hospitals of Montpellier and Clermont-Ferrand. The primary endpoint was immediate post-extubation hypoxemia, defined as a peripheral oxygen saturation (SpO2) <96%. Secondary endpoints included time from the end of the surgical procedure to patient able to be transferred to the ward. Patients extubated in the operating room were compared with patients extubated in the recovery room, before and after matching using a propensity score.Results: a total of 586 patients were included and analyzed. After extubation in the operating room, 52/344 patients (15%) experienced post-extubation hypoxemia, when compared with 64/214 patients (30%) after extubation in the recovery room (p<0.001, odds ratio OR 0.42, 95% confidence interval (CI) 0.28-0.63)). After matching, the rate of post-extubation hypoxemia was still lower in the operating room group (28/170 (16%)) when compared with recovery room (55/171 (32%), p<0.001, OR 0.42 95%CI (0.25-0.70)). Before and after matching, time from the end of the surgical procedure to patient able to be transferred to the ward was significantly lower in patients extubated in the operating room when compared with patients extubated in the recovery room.Conclusion: after abdominal surgery, extubation in the operating room was associated with fewer post-extubation hypoxemia than extubation in the recovery room, after careful adjustment.