Unplanned postoperative reintubation: a narrative review of risk factors, predictive tools, and preventive strategies

Unplanned postoperative reintubation is associated with increased morbidity, mortality, and healthcare use. Unplanned postoperative reintubation represents a heterogeneous clinical endpoint arising from distinct and often overlapping etiopathogenetic mechanisms, including airway compromise, respiratory insufficiency, cardiac dysfunction, neurological impairment and acute organ failure. Early reintubation need is more commonly associated with residual anaesthetic/neuromuscular blocker effects and airway-related factors, whereas intermediate and late restoration of invasive ventilation frequently reflects evolving respiratory, cardiac or multiorgan complications. Risk prediction models and advanced monitoring tools may support early identification of vulnerable patients but are limited by heterogeneous and variable predictive performance. Consequently, preventive strategies are most effective when tailored to specific phenotypes. A phenotype-based approach enables targeted surveillance and interventions, highlighting unplanned postoperative reintubation as a marker of perioperative vulnerability rather than a uniform pathology.