Background: This DNP project was a quality improvement project. The project was
designed to answer the following PICOT question: In adult surgical patients that undergo general
anesthesia and receive an endotracheal tube, does the use of the SPORC-2 risk stratification tool
reduce the risk of extubation failure within 72 hours after surgery?
This project took place at Kosciusko Community Hospital (KCH) in Warsaw Indiana.
The goal of this project was to improve the process of identification of the risk for extubation
failure in surgical candidates, and to ultimately decrease the rate of extubation failure. After an
extensive literature review, it was determined by this author and the facility that the Score for the
Prediction of Postoperative Respiratory Complications-2 (SPORC-2) was to be used to identify
risk (Lukannek et al., 2019). The SPORC-2 is a risk stratification tool that has been developed
and externally validated to determine the percent risk for extubation failure following anesthesia
via an endotracheal tube (Lukannek et al., 2019). The SPORC-2 was implemented in the
preoperative and intraoperative phase by anesthesia providers to identify risk of extubation
failure. Data analysis occurred to identify if the frequency of extubation failure was changed
significantly as a result of this QI project. This was determined through comparison of
preintervention data to postintervention data on the frequency and percentage of patients that
experience extubation failure.
Methodology: The timeline of this project began September of 2020, with the IRB review
completed at the University of Saint Francis. Support for the QI project was consistently
received since the introduction of the QI project in March of 2020. Support was granted from not
only anesthesia providers at KCH but also the operating room manager. After IRB at the
University of Saint Francis, implementation of the QI project began at KCH. The project was
5
implemented in November of 2020 and continued through January of 2021. The total duration of
project implementation and data collection was for three months. In February of 2021 data
collection occurred to compare preintervention data to postintervention data. Dissemination of
project results occurred in April of 2021.
Results: The preintervention results included 327 tracheal intubations with anesthesia
administration, four cases of reintubation after extubation, and six patients remained intubated
after surgery (D. Plautz, personal communication, February 1, 2021). The percentage of tracheal
intubations after extubation following the administration of general anesthesia for this timeframe
was 0.012%. The percentage of patients that remained intubated after anesthesia delivery was
0.018%.
The intervention phase resulted in 285 patients intubated. No patients during this time
were reintubated after tracheal extubation within 72 hours after extubation (0%). Six of these
patients remained intubated after anesthetic delivery (0.021%). Therefore, the frequency of
reintubation after extubation decreased and the frequency of patients that remained intubated
remained the same with an increase in the percentage by 0.003%.
Conclusion: The use of a risk stratification tool alone does not prove a reduced
occurrence of extubation failure. Instead, it is recommended that risk stratification tools be
paired with risk reduction techniques in anesthetic care delivery.

Creator

• Richard N. Kirby, BSN, RN, USF DNP-NAP Student

Keyword

• SPORC-2

• SPORC-2 risk stratification tool

• extubation

• extubation failure

• endotracheal tube

• Score for the Prediction of Postoperative Respiratory Complications-2

Date created

• May 23, 2021

Rights statement

• http://rightsstatements.org/vocab/InC/1.0/