Analysis of risk factors for delayed extubation after surgical anesthesia in obese patients undergoing abdominal laparoscopic surgery for gastrointestinal diseases: a single-center retrospective study.

BACKGROUND AND AIMS: Delayed extubation of the endotracheal tube (DE) can occur after surgical anesthesia. There has been particular interest in DE among patients with obesity (defined as BMI ≥ 30 kg/m² according to World Health Organization criteria), but the risk factors remain unclear. METHODS AND RESULTS: We aimed to identify risk factors for DE after abdominal laparoscopic gastrointestinal surgery. The incidence of DE in this setting was approximately 10%. Through multiple logistic regression, we identified multiple risk factors for DE. In the overall gastrointestinal cohort, BMI and age showed the strongest correlation with DE, with a combined AUC of 0.875. The cutoff values for BMI (31.765) and age (53.5 years) represent risk-discrimination thresholds for identifying patients at higher risk of DE. In the bariatric subgroup, the factors that showed the strongest discriminatory ability were BMI, age, male sex, propofol dosage, sevoflurane dosage, and fasting blood glucose, with a combined AUC of 0.920. The exploratory cutoffs-BMI 36.32, age 41.5 years, male sex, propofol 107.5 mL, sevoflurane 35 mL, and fasting blood glucose 5.935 mmol/L-may help identify patients at relatively higher risk of DE. CONCLUSIONS: BMI and age are the most reliable predictors of DE in patients undergoing gastrointestinal surgery. In addition to BMI and age, other important factors include male sex, dosages of propofol and sevoflurane, and fasting glucose levels. For patients with obesity, the combined influence of these factors yielded an AUC of 0.920 for predicting delayed extubation.