Background. Although early extubation after coronary bypass surgery has been shown to reduce length of stay, a systematic cost analysis of its economic benefit has not been reported, and previous studies have used hospital charges that are typically confused with actual costs. Methods. A consecutive series of 690 patients undergoing coronary bypass surgery during a 24-month period were studied to determine the effect of early extubation, defined as removal of the endotracheal tube within 8 hours of arrival to the intensive care unit, on length of stay and hospital costs. Patients in group 2 (n = 362) who underwent coronary bypass surgery in 1995, subsequent to the initiation of an early extubation protocol, were compared with those in group 1 (n = 328) operated on in 1994, before implementation of early extubation. To reflect true hospital resource consumption, only costs (not charges) directly related to patient health care (variable direct cost) were analyzed. Results. Baseline characteristics such as age, gender, previous myocardial infarctions, ejection fraction, reoperations, diabetes, and left main stenosis were similar in both groups. Operative mortality for the entire group was 3.3% and did not differ between the two groups; the incidence of serious morbidity was 10.9% for the entire group. Early extubation was accomplished in 38% of patients in group 2 versus 3% in group 12 (P < 0.001), and postoperative length of stay declined from 9.4 days to 7.7 days (p < 0.01). This was accompanied by a significant (p = 0.001) reduction in variable direct cost per case. Conclusions. Early extubation after coronary bypass surgery is an effective strategy of reducing length of stay and does not appear to impact on either morbidity or mortality. An additional benefit is significant cost savings realized through accelerated recovery and control of resource use.