Comparison of Operating Room Extubation Versus Post-Anesthesia Care Unit Extubation on Operating Room Efficiency : A Retrospective Cohort Study

Background: The impact of extubation location on perioperative efficiency and clinical outcomes remains inadequately characterized. This study investigated whether extubation in the Post-Anesthesia Care Unit (PACU) versus operating rooms (OR) independently associates with prolonged turnover intervals, postoperative complications, vasoactive drug requirements, and hemodynamic instability. Methods: We conducted a retrospective cohort study of 1016 adult patients undergoing surgeries requiring general anesthesia with tracheal intubation or laryngeal mask airway (LMA) placement between May 20th to May 24th 2024. Multivariable generalized linear models with gamma distributions analyzed turnover times. Ordinal logistic regression evaluated extubation site effects on adverse event counts and vasoactive agent tiers. Stratified analyses examined age (< 60 vs ≥ 60 years) and operative duration (≤1 vs > 1 h). Results: A total of 829 patients were ultimately analyzed in in the study. After adjusting for confounding factors, the PACU group demonstrated significantly longer Surgery End to Out of PACU time than the OR group (β, 0.156;95% CI, 0.100 to 0.212; P =0.000), as well as PACU duration (β, 0.358; 95% CI, 0.294 to 0.423; P =0.000), Surgery End to Extubation Time (β, 1.204; 95% CI, 0.927 to 1.122; P =0.000), and Induction to Extubation Time (β, 0.268; 95% CI, 0.212 to 0.324; P =0.000). Patients extubated in PACU required a greater variety of vascular agents (β, 0.872; 95% CI, 0.154 to 1.590; P = 0.017). They also had elevated blood pressure (β, 0.089; 95% CI, 0.065 to 0.113; P = 0.000) and heart rates (β, 0.067; 95% CI, 0.036 to 0.098; P = 0.000) at the time of extubation. The PACU group exhibited a significantly higher incidence of adverse events (OR, 2.636; 95% CI, 1.643 to 4.229; P = 0.000). Conclusions : Recovery room extubation independently associates with prolonged operational delays, heightened complication risks, and increased vasoactive support needs, particularly in older patients and prolonged surgeries. Clinical Trial Registration: This study was registered on April 7th, 2025 at ClinicalTrials. gov (No. ChiCTR2500100293).