Loneliness and nursing home admission among rural older adults

In this study, the authors tested the relation between loneliness and subsequent admission to a nursing home over a 4-year time period in a sample of approximately 3,000 rural older Iowans. Higher levels of loneliness were found to increase the likelihood of nursing home admission and to decrease the time until nursing home admission. The influence of extremely high loneliness on nursing home admission remained statistically significant after controlling for other variables, such as age, education, income, mental status, physical health, morale, and social contact, that were also predictive of nursing home admission. Several mechanisms are proposed to explain the link between extreme loneliness and nursing home admission. These include loneliness as a precipitant of declines in mental and physical health and nursing home placement as a strategy to gain social contact with others. Implications for preventative interventions are discussed.     

Perforating granuloma annulare

OBJECTIVE: To assess associations of adiposity with prevalent coronary heart disease (CHD) among elderly men. DESIGN: A cross-sectional epidemiologic study conducted between 1991 and 1993. SUBJECTS: 3741 Japanese-American men from the Honolulu Heart Program who were 71-93 y of age. MEASUREMENTS: CHD included documented myocardial infarction (electrocardiographic and enzyme criteria), acute coronary insufficiency, angina pectoris leading to surgical treatment identified through hospital surveillance, and reported history of heart attach or angina pectoris requiring hospitalization or surgical treatment. BMI was calculated as weight in kg divided by height in square meters. Waist circumference was measured at the horizontal level of the umbilicus and WHR was a ratio of waist circumference to hip circumference measured at the horizontal level of the maximal protrusion of the gluteal muscles. RESULTS: An elevated prevalence of CHD was observed in the elderly men with high BMI, WHR and waist circumference. The significant associations of BMI and waist circumference with CHD persisted after adjustment for fasting glucose, physical activity and pack-years of cigarette smoking but were no longer significant (odds ration (OR) = 1.03, 95% confidence level (CI) 0.94-1.12 and OR = 1.09, CI = 0.99-1.20, respectively) after adjustment for high density lipoprotein cholesterol (HDL-C). Also, the association of BMI with CHD was not found to be independent of abdominal adiposity. However, the associations of WHR and waist circumference remained significant (OR = 1.20, CI = 1.08-1.33 and OR = 1.17, CI = 1.01-1.37, respectively) after additional adjustment for BMI. In addition, the association of WHR with CHD was consistently significant and independent of fasting glucose, physical activity, smoking and HDL-C (OR = 1.11, CI = 1.00-1.23). CONCLUSION: WHR is associated with CHD independent of HDL-C and BMI, whereas the relation of BMI and waist circumference with CHD may be mediated through a relation of BMI and waist circumference with HDL-C level.     

Physical inactivity in New Zealanders aged 60 years and older

AIMS: To determine the prevalence of physical inactivity among older New Zealanders (> or = 60 years) and to examine the patterns of physical inactivity by sex, age, residential and cognitive status. METHODS: Information on housework-related and leisure-time physical activities obtained from the 910 controls in the Auckland Hip Fracture Study, was used to determine the prevalence of inactivity. Direct standardisation was used to extrapolate the inactivity prevalence figures from the study population to the general Auckland population. Logistic regression analyses were undertaken to examine the patterns of physical inactivity by sex, age, residential and cognitive status. RESULTS: Of the study participants 48.7% did not undertake any leisure-time physical activities and 15.6% did not undertake any physical activity. Extrapolation of these data to the Auckland population indicated that 38.9% of older people do not participate in any leisure time activity and 6.1% do not partake in any physical activity. Non-participation in physical activities was shown to be greater for women (odds ratio = 1.92; 95% confidence interval: 0.98-4.07); those in the older age groups (> or = 90 years, 7.00; 1.88-45.60); those living in institutions (6.52; 4.01-10.64); and for those who were cognitively impaired (13.96; 7.06-28.92). CONCLUSION: Policies and programmes should focus on encouraging and supporting older people to become physically more active, by engaging in activities in which they enjoy participating; by educating older people as to the feasibility and benefits of physical activities, including maintenance of an independent active life; and by encouraging residents in institutions to continue their involvement in housework-related activities, such as gardening, home maintenance and general housework.     

Loneliness is a unique predictor of age-related differences in systolic blood pressure.

A population-based sample of Caucasians, African Americans, and Latino Americans, 50-68 years of age (M = 57.5), from Cook County, Illinois (N = 229), was tested to examine how loneliness and co-occurring psychosocial factors (depressive symptoms, perceived stress, social support, and hostility) were related to indices of cardiovascular and endocrine functioning. Extending prior research, the authors found that loneliness was associated with elevated systolic blood pressure (SBP) and age-related increases in SBP, net of demographic variables, health behavior variables, and the remaining psychosocial factors. Loneliness was not associated with differences in autonomic or endocrine functioning. Although the results are limited by the cross-sectional methods used, they are consistent with the hypothesis that cardiovascular disease contributes to increased morbidity and mortality among lonely individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which lifestyle parameters discriminate high- from low-risk participants for coronary heart disease risk factors. Longitudinal analysis covering adolescence and young adulthood

BACKGROUND: The purpose of this study was to analyse which lifestyle parameters (daily physical activity, dietary intake, smoking habits and alcohol consumption) discriminate between participants at high-risk and those at low-risk for coronary heart disease (CHD) [systolic and diastolic blood pressure (SBP/DBP), total serum cholesterol (TC), high-density lipoprotein cholesterol (HDL), the TC: HDL ratio, body fatness (sum of skinfolds [SSF]) and cardiopulmonary fitness (VO2-max)]. METHODS: The data were derived from the Amsterdam Growth and Health Study (AGHS); an observational longitudinal study in which six repeated measurements were carried out over a period of 15 years on 181 participants aged 13 years at entry to the study. To assess possible discriminating factors, generalized estimating equations were used. This method makes use of risk group changing behaviour over time by using all available longitudinal data. RESULTS: For DBP no significant relationships were found; high risk for SBP was inversely related to smoking habits (OR=0.52; P<0.01). No significant relationships were found for TC; high risk for HDL was positively related to the intake of carbohydrates (OR=1.2; P=0.02) and to smoking habits (OR=1.6; P=0.04); high risk for the TC:HDL ratio was positively related to the intake of carbohydrates (OR=1.3; P=0.01). High risk for SSF was positively related to the intake of protein (OR=1.5; P<0.01) and smoking habits (OR=1.8; P=0.01) and inversely related to daily physical activity (OR=0.81; P=0.01). High risk for VO2-max was inversely related to daily physical activity (OR=0.67; P<0.01). CONCLUSIONS: In the relative young and healthy population of the AGHS during adolescence and young adulthood, physical inactivity was the most important lifestyle parameter related to high risk for CHD.     

Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study.

We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50–68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Loneliness impairs daytime functioning but not sleep duration.

Objective: To assess the prospective association between daily feelings of loneliness and subsequent feelings of daytime dysfunction indicative of poor sleep quality. Design: Three consecutive end-of-day diaries were completed by a population-based sample of 215 adults (mean age = 57.5 years, SD = 4.4). Diary questions probed sleep duration, daytime dysfunction (i.e., fatigue, low energy, sleepiness), loneliness, physical symptoms, and depressed affect experienced that day. Chronic health condition data and body mass index were also obtained. Autoregressive cross-lagged panel models were used to examine the magnitude of reciprocal prospective associations between loneliness and daytime dysfunction. Main Outcome Measures: Unstandardized path coefficients adjusted for race/ethnicity, sleep duration, marital status, household income, chronic health conditions, and health symptom severity. Results: Daily variations in loneliness predicted subsequent feelings of daytime dysfunction (B = 0.16, p     

The influence of health-related quality of life and social characteristics on hospital use by patients with AIDS in the Boston Health Study

OBJECTIVES: The authors examine whether health-related quality of life (HRQL) and social factors were independent predictors of future hospital use for persons with acquired immunodeficiency syndrome (AIDS). METHODS: A panel of 305 patients with AIDS treated at three provider settings in the Boston, Massachusetts area were enrolled during 1990 and 1991. Data were collected at baseline study enrollment and again 4 months later. Patient interviews, hospital bills, and medical charts were used to measure hospital use (admissions and days during the 4 months after enrollment), sociodemographic characteristics (age, gender, race, education, insurance, homelessness, alcohol use, and AIDS risk factors), disease burden (patient severity and a three-level opportunistic diseases and complications score), HRQL (patient-reported symptoms, activities of daily living, neuropsychological status, and global health assessment), system of care, and use of prophylactic drugs. Logistic regression was used to estimate the odds of admission. Total days of hospital care by patients with at least one admission were analyzed using multiple linear regression. Clinical models of hospital use were developed first from the variables measuring disease burden and system of care. Models estimating the associations between hospital use and all other predictor variables measured at baseline then were estimated using stepwise techniques, controlling for variables in the core model. RESULTS: Patients were more likely than their reference groups to be hospitalized if they had serious opportunistic diseases (adjusted odds ratio [OR] = 2.7), had poorer neuropsychological status (OR = 1.9), were non-white (OR = 2.0), or were homeless (OR = 3.3) (all P < or = 0.05). Activities of daily living were associated moderately (OR = 1.3; P = 0.07). Only system of care and neuropsychological status predicted total hospital days. CONCLUSIONS: The results indicate that future hospital use by persons with AIDS may be influenced by social and other health-related factors in addition to the more clinically related characteristics that are recorded in a medical chart. It therefore may be appropriate to assess these factors when considering options for intervention or when comparing patterns of use among patient groups or settings.     

"Perceived environmental predictors of physical activity over 6 months in adults: Activity Counseling Trial": Correction to Sallis et al. (2007).

Reports an error in "Perceived environmental predictors of physical activity over 6 months in adults: Activity Counseling Trial" by James F. Sallis, Abby C. King, John R. Sirard and Cheryl L. Albright (Health Psychology, 2007[Nov], Vol 26[6], 701-709). One result in Table 2 was misinterpreted in the text. It was reported that men who responded "yes" to frequently seeing people being active in their neighborhoods did about 75 minutes more physical activity per week (p2007-16656-008.) Purpose: In the present study, the authors extend previous cross-sectional findings by using a prospective design to determine whether physical and social environmental characteristics predict physical activity over 6 months. Design: Inactive adults were recruited to the Activity Counseling Trial, a multicenter, randomized, controlled trial of physical activity intervention in primary care. Participants were 387 women and 474 men aged 35-75 years in 3 regions; 1/3 were minorities; 56% had some college education. Baseline perceived environmental variables were used to predict physical activity at 6 months, adjusting for experimental condition and other potential moderators. Measures: The validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. A standardized survey was used to measure social and physical environmental variables around the home and neighborhood. Results: Women reporting no unattended dogs and low crime in their neighborhoods and men reporting frequently seeing people being active in their neighborhoods did 50-75 more minutes of physical activity per week than did those with different environmental characteristics. Interactions of environmental variables with age group suggested that older adults may be more affected by environmental variables than are younger adults. Conclusions: Self-reported social and physical environmental variables were significantly related to moderate to vigorous physical activity among a diverse sample of adults living in 3 regions of the United States. These prospective findings strengthen the conclusion from previous cross-sectional studies that environmental variables are important correlates of physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Job Strain, Job Insecurity, and Health: Rethinking the Relationship.

Job strain (high demands and low control) is a widely used measure of work stress. The authors introduce a new way of looking at work stress by combining job strain with job insecurity, a combination increasingly prevalent in contemporary economies, using data from a cross-sectional survey (N = 1,188) of mid-aged Australian managers and professionals. Those reporting both strain and insecurity showed markedly higher odds for mental and physical health problems (depression: odds ratio [OR] 13.88, 95% confidence interval [CI] 5.67-34.01; anxiety: OR 12.88, CI 5.12-32.39; physical health problems: OR 3.97, CI 1.72-9.16; and poor self-rated health: OR 7.12, CI 2.81-18.01). Job strain and insecurity showed synergistic associations with health, and employees experiencing both could be at heightened health risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived environmental predictors of physical activity over 6 months in adults: Activity Counseling Trial.

[Correction Notice: An erratum for this article was reported in Vol 27(2) of Health Psychology (see record 2008-12766-001). One result in Table 2 was misinterpreted in the text. It was reported that men who responded "yes" to frequently seeing people being active in their neighborhoods did about 75 minutes more physical activity per week (pPurpose: In the present study, the authors extend previous cross-sectional findings by using a prospective design to determine whether physical and social environmental characteristics predict physical activity over 6 months. Design: Inactive adults were recruited to the Activity Counseling Trial, a multicenter, randomized, controlled trial of physical activity intervention in primary care. Participants were 387 women and 474 men aged 35-75 years in 3 regions; 1/3 were minorities; 56% had some college education. Baseline perceived environmental variables were used to predict physical activity at 6 months, adjusting for experimental condition and other potential moderators. Measures: The validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. A standardized survey was used to measure social and physical environmental variables around the home and neighborhood. Results: Women reporting no unattended dogs and low crime in their neighborhoods and men reporting frequently seeing people being active in their neighborhoods did 50-75 more minutes of physical activity per week than did those with different environmental characteristics. Interactions of environmental variables with age group suggested that older adults may be more affected by environmental variables than are younger adults. Conclusions: Self-reported social and physical environmental variables were significantly related to moderate to vigorous physical activity among a diverse sample of adults living in 3 regions of the United States. These prospective findings strengthen the conclusion from previous cross-sectional studies that environmental variables are important correlates of physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educational differences in leisure-time physical inactivity: a descriptive and explanatory study

In this study we aim to explain educational differences in leisure-time physical inactivity in terms of psychosocial and material factors. Cross-sectional data were obtained from the baseline of the Dutch GLOBE study in 1991, including 2598 men and women, aged 15-74 years. Physical inactivity during leisure time was defined as not participating in any activity, such as sports, gardening, walking or cycling. Psychosocial factors included in the study were coping resources, personality, and stressors. Material factors were financial situation, employment status, and living conditions. Logistic regression models were used to calculate educational differences in physical inactivity. Physical inactivity was more prevalent in lower educational groups. Psychosocial factors related to physical inactivity were locus of control, parochialism, neuroticism, emotional social support, active problem focussing, optimistic and palliative coping styles. Material factors associated with physical inactivity were income, employment status and financial problems. All correlates of physical inactivity were unequally distributed over educational groups, except optimistic and palliative coping. Personality and coping style were the main contributors to the observed educational differences in physical inactivity. That is to say, parochialism, locus of control, neuroticism and active problem focussing explained about half of elevated odds ratios of physical inactivity in the lower educational groups. The material factors, equivalent income and employment status explained about 40% of the elevated odds ratios. Psychosocial and material correlates together reduced the odds ratios of lower educational groups by on average 75%. These results have practical consequences for the design of more effective interventions to promote physical activity. In particular, personality and coping style of risk groups, such as lower educational groups, should be taken into consideration at the future development of these interventions, as well as inequalities in material restrictions related to engaging in physical activity. Supplementary interventions focussing on childhood conditions which, partly, influence both personality and physical inactivity may also contribute to a reduction of socio-economic differences in physical inactivity.     

Loneliness and the metabolic syndrome in a population-based sample of middle-aged and older adults.

Objective: This study evaluated the association between loneliness and the metabolic syndrome, which refers to a clustering of factors that have been shown to increase risk for cardiovascular disease, diabetes, stroke, and mortality. A secondary purpose was to evaluate whether age moderated the association between loneliness and the metabolic syndrome. Design: Participants were 52 to 79 years old, and they were drawn from a population-based survey of people 50 years of age and older living in England (N = 3211). They completed a self-report measure of loneliness and a nurse visit that included collection of blood pressure, blood sample, and anthropometric measures. Main Outcome Measures: Self-reported loneliness and the metabolic syndrome. Results: After controlling for demographic variables and smoking status, loneliness was significantly associated with increasing likelihood of meeting criteria for the metabolic syndrome and with the individual criterion of central obesity. The association between loneliness and the metabolic syndrome was not moderated by age. Conclusion: Results suggest that loneliness is associated with the metabolic syndrome. Therefore, the metabolic syndrome may be among the pathways by which loneliness increases risk of morbidity and mortality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prolonged surgery increases the likelihood of admission of scheduled ambulatory surgery patients

STUDY OBJECTIVE: To identify variables influencing the likelihood of unanticipated admission following scheduled ambulatory surgery. DESIGN: Retrospective case-controlled chart review study. SETTING: A large academic tertiary care hospital. PATIENTS: 8,549 ASA physical status I, II, III, and IV patients who underwent scheduled ambulatory surgery in 1991. MEASUREMENTS AND MAIN RESULTS: Of the 8,549 patients, 216 were admitted, with complete medical record information available for 167 of the admitted patients. The most common reasons for admission among the 167 were surgical (43%), anesthetic (28%), and medical (17%) complications. Odds for admission following long surgery (of at least 60 minutes) were 7.5 times (p < 0.001) greater than following short surgery (under 60 minutes). Among long cases, independent variables influencing admission were: general anesthesia [odds ratio 20.8; 95% confidence interval (CI) 4.4 to 45.6], and monitored anesthesia care or regional anesthesia (combined odds ratio 8.3; 95% CI 1.7 to 40.8). ASA physical status and patient age did not significantly influence admission rate for long cases. For short cases, patients over 65 years (odds ratio 5.6; 95% CI 2.6 to 12.0), ASA physical status III or IV (odds ratio 4.8; 95% CI 2.0 to 11.6), use of general anesthesia (odds ratio 4.7; 95% CI 1.5 to 14.2), and monitored anesthesia care or regional anesthesia (odds ratio 3.1; 95% CI 1.0 to 10.1) independently influenced the likelihood of admission. Type of surgery and gender had no detectable effect on admission. CONCLUSIONS: Surgery duration of 60 minutes or longer was the most important predictor of unanticipated admission following scheduled ambulatory surgery.     

Evaluation of the immunospecificity of the porin Om1 of Vibrio anguillarum serotype O1

PURPOSE: To evaluate the relationship between indicators of physical activity and health-related fitness in youth 9-18 yr. METHODS: A cross-sectional sample of 356 boys and 284 girls 9-18 yr of age from phase I of the Quebec Family Study was studied. The sample was divided into three age groups by gender, 9-12, 13-15, and 16-18 yr of age. Physical activity variables included two estimates of activity, estimated daily energy expenditure (EE) and estimated moderate-to-vigorous physical activity (MVPA), and one estimate of inactivity, time spent watching television per day (TVTIME). Health-related fitness variables were the sum of six skin folds (SUM), number of sit-ups in 1 min (SITUP), physical work capacity at 150 beats x min(-1) (PWC150), and static strength of the leg (LMS). Partial canonical correlation was used to quantify the relationship between standardized (z-transformed) activity variables and health-related fitness items, controlling for age. RESULTS: There is a weak to moderate association between physical activity and fitness in youth. The first activity canonical variate is a function of positive loadings for EE and MVPA, with a smaller, negative loading for TVTIME. The first fitness variate generally includes positive loadings for PWC150 and SITUP, with a small negative loading for the SUM and a small positive loading for LMS. The first canonical correlations indicate that the variance shared by the fitness and activity variates ranges from 11 to 21%. CONCLUSION: There is a significant relationship between activity and health-related physical fitness, but a large part of the variability (80-90%) in fitness is not accounted for by physical activity as measured in this study.     

Transient global amnesia after general anesthesia

OBJECTIVE: To investigate the prevalence of coronary artery disease (CAD), atherothrombotic brain infarction (ABI), and peripheral arterial disease (PAD) in older Hispanics and the association with risk factors in this population. DESIGN: A retrospective analysis of charts from all Hispanics seen during January 1996 through July 1997 at an academic hospital-based geriatrics practice. SETTING: An academic, hospital-based, primary care geriatrics practice staffed by fellows in a geriatrics training program and by full-time faculty geriatricians. PATIENTS: One hundred sixty women and 53 men, mean age 80 +/- 8 years (range 64 to 100), were included in the study. MEASUREMENTS AND MAIN RESULTS: Of 213 Hispanics in the study, 59 (28%) had documented CAD, 43 (20%) had ABI, 34 (16%) had PAD, and 90 (42%) had either CAD, ABI, or PAD. Serum total cholesterol and triglycerides were measured in 202 of 213 subjects (95%). Serum high-density lipoprotein cholesterol was measured in 137 of 213 patients (64%). Other risk factor data were documented in all patients. Multiple logistic regression analysis performed in 202 patients using the variables age, gender, cigarette smoking, hypertension, diabetes mellitus, obesity, serum total cholesterol, and serum triglycerides showed statistically significant associations between prevalent CAD, ABI, or PAD and age (P = .002, odds ratio (OR) = 1.083), cigarette smoking (P = .002, (OR) = 3.865), hypertension (P = .007, (OR) = 2.749), diabetes mellitus (P = .028, (OR) = 2.386), obesity (P = .014, (OR) = 2.608), serum total cholesterol (P < 0.001, (OR) = 1.025), and serum triglycerides (P = .017, (OR) = .993). CONCLUSIONS: Either CAD, ABI, or PAD was present in 42% of 213 older Hispanics. There were statistically significant associations between prevalent CAD, ABI, or PAD in older Hispanics and risk factors, including age, cigarette smoking, hypertension, diabetes mellitus, obesity, and serum total cholesterol.     

Early predictors of sexually intimate behaviors in an urban sample of young girls.

In recent years, concern has been raised about girls’ involvement in sexual activity at progressively younger ages. Little is known about the prevalence of emerging intimate behaviors, the psychosocial factors associated with these behaviors, or the moderating effects of ethnicity on these associations in early adolescence. In the current prospective study, we examined the prevalence and predictors of sexually intimate behaviors at age 12 years in an urban community sample of 1,116 ethnically diverse girls. Cluster analysis revealed 3 groups at age 12: no sexual behavior, mild behavior (e.g., holding hands), and moderate behavior (e.g., laying together). Minority status girls reported higher rates of both mild and moderate sexually intimate behaviors compared with European American girls. After controlling for the significant effects of age 11 intimate behaviors, lifetime alcohol use, poor parent–child communication, deviant peer behavior, onset of menarche, and interactions between ethnicity and impulsivity, social self-worth and depression uniquely increased the odds of engaging in moderately intimate behaviors at age 12 years. Parenting characteristics increased the likelihood of moderate, relative to mild, behaviors. For European American girls only, high levels of impulsivity and low social self-worth were associated with a higher likelihood of engaging in moderate intimate behaviors, whereas high levels of depressive symptoms reduced the odds. The results suggest that early prevention efforts need to incorporate awareness of different social norms relating to sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Up and Down in Middle Age: Monotonic and Nonmonotonic Changes in Roles, Status, and Personality.

It is proposed that personality (conceptualized in terms of motives and psychological resources) changes normatively not only from young adulthood to middle age but also within middle age and that these changes take place in relation to social and biosocial change over the same period. Data from 123 women studied at ages 27, 43, 52, and 61 largely supported hypotheses about change in social roles, status, health, motives, personality characteristics, emotion regulation, and relationships. Noteworthy aspects of the findings were substantial curvilinear change within middle age and associations of work involvement and physical health with personality change during late middle age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early extubation following cardiac surgery in a veterans population

BACKGROUND: Early tracheal extubation is an important component of the "fast track" cardiac surgery pathway. Factors associated with time to extubation in the Department of Veterans Affairs (DVA) population are unknown. The authors determined associations of preoperative risk and intraoperative clinical process variables with time to extubation in this population. METHODS: Three hundred four consecutive patients undergoing coronary artery bypass graft, valve surgery, or both on a fast track clinical pathway between October 1, 1993 and September 30, 1995 at a university-affiliated DVA medical center were studied retrospectively. After univariate screening of a battery of preoperative risk and intraoperative clinical process variables, stepwise logistic regression was used to determine associations with tracheal extubation < or = 10 h (early) or > 10 h (late) after surgery. Postoperative lengths of stay, complications, and 30-day and 6-month mortality rates were compared between the two groups. RESULTS: One hundred forty-six patients (48.3%) were extubated early; one patient required emergent reintubation (0.7%). Of the preoperative risk variables considered, only age (odds ratio, 1.80 per 10-yr increment) and preoperative intraaortic balloon pump (odds ratio, 7.88) were multivariately associated with time to extubation (model R) ("late" association is indicated by an odds ratio >1.00; "early" association is indicated by an odds ratio <1.00). Entry of these risk variables into a second regression model, followed by univariately significant intraoperative clinical process variables, yielded the following associations (model R-P): age (odds ratio, 1.86 per 10-yr increment), sufentanil dose (odds ratio, 1.54 per 1-microg/kg increment), major inotrope use (odds ratio, 5.73), platelet transfusion (odds ratio, 10.03), use of an arterial graft (odds ratio, 0.32), and fentanyl dose (odds ratio, 1.45 per 10-microg/kg increment). Time of arrival in the intensive care unit after surgery was also significant (odds ratio, 1.42 per 1-h increment). Intraoperative clinical process variables added significantly to model performance (P < 0.001 by the likelihood ratio test). CONCLUSIONS: In this population, early tracheal extubation was accomplished in 48% of patients. Intraoperative clinical process variables are important factors to be considered in the timing of postoperative extubation after fast track cardiac surgery.