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Yeom R, Gorgone M, Malinovic M, Panzica P, Maslow A, Augoustides JG, Marchant BE, Fernando RJ, Nampi RG, Pospishil L, Neuburger PJ. Surgical Aortic Valve Replacement in a Patient with Very Severe Chronic Obstructive Pulmonary Disease. J Cardiothorac Vasc Anesth 2023; 37:2335-2349. [PMID: 37657996 DOI: 10.1053/j.jvca.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Richard Yeom
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Michelle Gorgone
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Matea Malinovic
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Peter Panzica
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bryan E Marchant
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Robert G Nampi
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
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Zhao J. Study on Health Care Service Standard of Chronic Disease Management Based on Process Reengineering and the Delphi Method. Appl Bionics Biomech 2022; 2022:6713140. [PMID: 36245935 PMCID: PMC9553666 DOI: 10.1155/2022/6713140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
The Delphi method is also called an expert consultation method, scientifically measuring the objectivity, practicality, and authority of the metric. This study aims to build a standard plan for chronic disease management care services in hospitals and guide the development of chronic disease management care services. This article proposes a chronic disease management nursing experiment, further revises the current hospital chronic disease management nursing service, redesigns the program, compiles the chronic disease management hospital nursing standard list according to the new program, and uses expert suggestions to modify the standard program items. It adopts a preliminary expert inquiry table, submits Delphi expert inquiry, and constructs a chronic patient prevention strategy for clinical nursing practice to learn from the reference for guiding the actual specific situation of nursing, providing evidence basis and practice guidance. More than 40 initial standards were listed, which were reduced to 30 after revision. The importance of the indicators to different experts was 3.56 to 4.85 points. The coordination coefficient is 0.180~0.356. Finally, after discussion by all parties, more than 40 specific indicators including the size of the new standard have been determined, which provides a great theoretical basis for the establishment of a new type of hospital chronic disease management and nursing service standard in my country. Based on process reconstruction and the Delphi method determined by the hospital chronic disease management nursing service standards, clear normative and operability can provide basis for the development of chronic disease management nursing services.
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Affiliation(s)
- Jing Zhao
- Nursing Department, West Anhui Health Vocational College, Lu'an 237000, China
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Gao J, Wang H, Liu X, Song X, Zhong X. Surgical site wound infection, and other postoperative problems after coronary artery bypass grafting in subjects with chronic obstructive pulmonary disease: A meta-analysis. Int Wound J 2022; 20:302-312. [PMID: 35801278 PMCID: PMC9885461 DOI: 10.1111/iwj.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/03/2023] Open
Abstract
We performed a meta-analysis to evaluate the effect of chronic obstructive pulmonary disease on surgical site wound infection, and other postoperative problems after coronary artery bypass grafting. A systematic literature search up to April 2022 was performed and 37 444 subjects with coronary artery bypass grafting at the baseline of the studies; 4320 of them were with the chronic obstructive pulmonary disease, and 33 124 were without chronic obstructive pulmonary disease. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of chronic obstructive pulmonary disease on surgical site wound infection, and other postoperative problems after coronary artery bypass grafting using the dichotomous, and contentious methods with a random or fixed-effect model. The chronic obstructive pulmonary disease subjects had a significantly higher surgical site wound infection (OR, 1.27; 95% CI, 1.01-1.60, P = 0.04), respiratory failure (OR, 1.84; 95% CI, 1.55-2.18, P < 0.001), mortality (OR, 1.61; 95% CI, 1.37-1.89, P < 0.001), pneumonia (OR, 2.30; 95% CI, 1.97-2.68, P < 0.001), pleural effusion (OR, 1.78; 95% CI, 1.12-2.83, P = 0.02), stroke (OR, 1.99; 95% CI, 1.17-3.36, P = 0.01), and length of intensive care unit stay (MD, 0.73; 95% CI, 0.19-1.26, P = 0.008) after coronary artery bypass grafting compared with subjects without chronic obstructive pulmonary disease. However, chronic obstructive pulmonary disease subjects did not show any significant difference in length of hospital stay (MD, 0.83; 95% CI, -0.01 to 1.67, P = 0.05), and pneumothorax (OR, 1.59; 95% CI, 0.98-2.59, P = 0.06) after coronary artery bypass grafting compared with subjects without chronic obstructive pulmonary disease. The chronic obstructive pulmonary disease subjects had a significantly higher surgical site wound infection, respiratory failure, mortality, pneumonia, pleural effusion, stroke, and length of intensive care unit stay, and no significant difference in length of hospital stay, and pneumothorax after coronary artery bypass grafting compared with subjects without chronic obstructive pulmonary disease. The analysis of outcomes should be with caution because of the low sample size of 1 out of 11 studies in the meta-analysis and a low number of studies in certain comparisons.
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Affiliation(s)
- Jinglin Gao
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China,Department of Rheumatism and ImmunologyThe Fourth Affiliated Hospital of Guangxi Medical UniversityLiuzhouPeople's Republic of China
| | - Huijuan Wang
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
| | - Xiuhua Liu
- Department of Rheumatism and ImmunologyThe Fourth Affiliated Hospital of Guangxi Medical UniversityLiuzhouPeople's Republic of China
| | - Xinghui Song
- Department of Rheumatism and ImmunologyThe Fourth Affiliated Hospital of Guangxi Medical UniversityLiuzhouPeople's Republic of China
| | - Xiaoning Zhong
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
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Yang L, Zhang Y, Yao W, Fang F, Li W. Impact of Chronic Obstructive Pulmonary Disease on Infectious Complications and Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2021; 12:723115. [PMID: 34867713 PMCID: PMC8634885 DOI: 10.3389/fneur.2021.723115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear. Methods: In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2014 and 2019. Propensity score matching analysis and cox regression models was used to assess the association between COPD and mortality. The primary outcome was long-term mortality. Results: Using a clinical database from a large university medical center, 2,925 patients with aSAH were identified, of whom 219 (7.5%) also had COPD. Patients were followed-up for a median of 3.8 years, and during follow-up 633 patients (21.6%) died. Long-term mortality was higher in patients with COPD compared to patients without COPD in the Cox regression models [adjusted hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.14–2.02]. Propensity score matching analysis also showed similar associations between COPD and mortality in hospital, at 1 year, at 2 years, and at long-term. Similarly, patients with COPD had significantly higher incidence of infections, such as pneumonia [odds ratio (OR) 3.24, 95% CI 2.30–4.56], urinary tract infection (OR 1.81, 95% CI 1.20–2.73), bloodstream infection (OR 3.83, 95% CI 1.84–7.99), and hospital infection (OR 3.24, 95% CI 2.28–4.61). Conclusions: Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for infections. Given that these are preventable complications, our findings are of clinical relevance.
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Affiliation(s)
- Lan Yang
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhang
- Department of Neurosurgery, West China Medical School/West China Hospital, Sichuan University, Chengdu, China.,Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Shenyang, China
| | - Fang Fang
- Department of Neurosurgery, West China Medical School/West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, China
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Kazantsev AN, Tarasov RS, Burkov NN, Anufriyev AI, Lazukina IA, Sargsyan MT, Soldatov EO, Grachev KI, Kutikhin AG, Lider RY. [Progression of precerebral atherosclerosis and predictors of ischemic complications in cardiac patients]. Khirurgiia (Mosk) 2020:31-38. [PMID: 32736461 DOI: 10.17116/hirurgia202007131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify predictors of progression of precerebral atherosclerosis in long-term period after coronary artery bypass surgery. MATERIAL AND METHODS There were 97 procedures of carotid endarterectomy in patients after previous coronary artery bypass grafting for the period from 2006 to 2017. Inclusion criteria were previous CABG, no significant (over 60%) stenosis of internal carotid arteries at discharge after CABG. The control group included 447 patients without progression of precerebral atherosclerosis in long-term period after CABG. RESULTS Careful monitoring of progression of precerebral atherosclerosis and therapeutic prevention of ischemic stroke are required in patients with mild-to-moderate ICA stenosis after CABG. The most significant predictors of progression of precerebral atherosclerosis after CABG were AF (OR=1.97, 95% CI 1.04-3.73), previous occlusion of stent (OR=7.89, 95% CI=2.3-27.0), chronic brain ischemia grade II or III (OR=22.45, 95% CI=11.9-42.3), chronic kidney disease (OR=15.8, 95% CI=5.04-49.5). CONCLUSION It was revealed that the majority of predictors of adverse ischemic cerebral and myocardial events are indirectly associated with atrial fibrillation.
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Affiliation(s)
- A N Kazantsev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - R S Tarasov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - N N Burkov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - A I Anufriyev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | | | - M T Sargsyan
- Kemerovo State Medical University, Kemerovo, Russia
| | - E O Soldatov
- Kemerovo State Medical University, Kemerovo, Russia
| | - K I Grachev
- Kemerovo State Medical University, Kemerovo, Russia
| | - A G Kutikhin
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russia
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Szylińska A, Kotfis K, Listewnik M, Brykczyński M, Marra A, Rotter I. The burden of chronic obstructive pulmonary disease in open heart surgery-a retrospective cohort analysis of postoperative complications: STROBE compliant. Medicine (Baltimore) 2020; 99:e19675. [PMID: 32221097 PMCID: PMC7220196 DOI: 10.1097/md.0000000000019675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has a major impact on mortality and morbidity in patients undergoing cardiac surgery. Mortality risk increases by 50% in patients who were re-intubated or required prolonged mechanical ventilation after the operation. The aim of this study was to assess the impact of COPD on the prediction of postoperative complications and outcome including intensive care unit (ICU) and hospital stay, postoperative morbidity and mortality in patients undergoing all types of cardiac surgery.We performed a retrospective cohort analysis of prospectively collected data from a tertiary cardiac surgery department of a university hospital between 2014 and 2016. We divided patients undergoing cardiac surgery into 2 sub-groups - the first - with a clinical diagnosis of COPD (n = 198) and the second comprised all other non-COPD patients (n = 2980).Among patients with COPD a longer intubation time (P = .039), longer ICU stay (P < .001) and longer hospitalization time (P = .006) was noted as compared with non-COPD patients. Patients with COPD required reintubation more often than non-COPD patients, reintubation occurring twice, 19 (9.60%) versus 144 (4.83%) P = .002, reintubation occurring 3 or more times, 7 (3.54%) versus 34 (1.14%) P = .006. Mortality within 30 days after surgery was higher in patients with pulmonary problems before surgery (P = .003). Multivariable logistic regression analysis corrected for interfering variables showed an increased risk of postoperative bronchoconstriction (odds ratio [OR] = 4.40, P = .002), respiratory failure (OR = 1.67, P = .018), atrial fibrillation (OR = 1.45, P = .023), and use of hemofiltration (OR = 1.60, P = .029) for patients with COPD.Patients with COPD undergoing all types of cardiac surgery are at increased risk of respiratory complications and mortality. The occurrence of COPD was associated with longer ICU and hospital stay. In COPD patients, undergoing cardiac surgery, treatment strategies aimed at preventing reintubation and early weaning mechanical ventilation must be employed to reduce postoperative complications.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, ul. Żołnierska 54
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University
| | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University, al. Powstańców Wlkp. 72, Szczecin, Poland
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, Pomeranian Medical University, al. Powstańców Wlkp. 72, Szczecin, Poland
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, Naples, Italy
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, ul. Żołnierska 54
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Huang W, Xie R, Hong Y, Chen Q. Association Between Comorbid Chronic Obstructive Pulmonary Disease and Prognosis of Patients Admitted to the Intensive Care Unit for Non-COPD Reasons: A Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2020; 15:279-287. [PMID: 32103927 PMCID: PMC7012221 DOI: 10.2147/copd.s244020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Aim Chronic obstructive pulmonary disease (COPD) is a rather common comorbid condition among patients admitted to the intensive care unit (ICU), while evidence of how this comorbidity affects prognosis is limited. This study aimed to investigate the associations between COPD comorbidity and prognoses of patients who were admitted to the ICU for non-COPD reasons, and to examine whether the associations varied between different types of ICU. Methods A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). Adult (≥18 years) patients of first ICU admission in the database were enrolled as study participants but those with a primary diagnosis of COPD were excluded. The primary endpoint was 28-day mortality after ICU admission and multivariable Cox regression analyses were employed to assess the associations between COPD comorbidity and the study endpoints. Different adjusting models including a propensity score were used to adjust potential confounders. Results A total of 29,499 patients were enrolled finally, among which 3,332 patients (11.30%) were comorbid with COPD. A higher 28-day mortality was observed among patients with COPD than those without COPD (13.90% versus 8.07%, P<0.001), but there was no statistically significant difference in the proportion of patients who needed mechanical ventilation on the first day after ICU admission between the two groups. Multivariable Cox regression analyses found a significant association between COPD comorbidity and 28-day mortality (adjusted hazard ratio=1.32, 95% confidence interval=1.19-1.47, P<0.0001). The associations were broadly consistent among patients admitted to different types of ICU, but a much higher estimate was observed in patients admitted to cardiac surgery recovery unit (adjusted hazard ratio=2.03, 95% confidence interval=1.44-2.86, P<0.0001). Conclusion Comorbid COPD increased the risk of 28-day mortality among patients admitted to the ICU for non-COPD reasons, especially for those admitted to the cardiac surgery recovery unit.
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Affiliation(s)
- Wencheng Huang
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, People's Republic of China
| | - Ruijie Xie
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yuancheng Hong
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, People's Republic of China
| | - Qingui Chen
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Survival, Quality of Life, and Functional Status Following Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review. Crit Care Med 2019; 47:e52-e63. [PMID: 30398978 DOI: 10.1097/ccm.0000000000003504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Compared with noncardiac critical illness, critically ill postoperative cardiac surgical patients have different underlying pathophysiologies, are exposed to different processes of care, and thus may experience different outcome trajectories. Our objective was to systematically review the outcomes of cardiac surgical patients requiring prolonged intensive care with respect to survival, residential status, functional recovery, and quality of life in both hospital and long-term follow-up. DATA SOURCES MEDLINE, Embase, CINAHL, Web of Science, and Dissertations and Theses Global up to July 21, 2017. STUDY SELECTION Studies were included if they assessed hospital or long-term survival and/or patient-centered outcomes in adult patients with prolonged ICU stays following major cardiac surgery. After screening 10,159 citations, 114 articles were reviewed in full; a final 34 articles met criteria for data extraction. DATA EXTRACTION Two reviewers independently extracted data and assessed risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Studies. Extracted data included the used definition of prolonged ICU stay, number and characteristics of prolonged ICU stay patients, and any comparator short stay group, length of follow-up, hospital and long-term survival, residential status, patient-centered outcome measure used, and relevant score. DATA SYNTHESIS The definition of prolonged ICU stay varied from 2 days to greater than 14 days. Twenty-eight studies observed greater in-hospital mortality among all levels of prolonged ICU stay. Twenty-five studies observed greater long-term mortality among all levels of prolonged ICU stay. Multiple tools were used to assess patient-centered outcomes. Long-term health-related quality of life and function was equivalent or worse with prolonged ICU stay. CONCLUSIONS We found consistent evidence that patients with increases in ICU length of stay beyond 48 hours have significantly increasing risk of hospital and long-term mortality. The significant heterogeneity in exposure and outcome definitions leave us unable to precisely quantify the risk of prolonged ICU stay on mortality and patient-centered outcomes.
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Zhao H, Li L, Yang G, Gong J, Ye L, Zhi S, Zhang X, Li J. Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery: A meta-analysis. Medicine (Baltimore) 2019; 98:e14388. [PMID: 30732179 PMCID: PMC6380818 DOI: 10.1097/md.0000000000014388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a frequent comorbid disease in patients undergoing coronary artery bypass grafting (CABG) surgery, with an incidence ranging from 4% to 20.5%. Conventionally, COPD was recognized as a surgical contraindication to CABG. Because of the recent improvements in surgical techniques, anesthesia, and postoperative management, CABG has been performed more commonly in patients with COPD. However, studies have shown the various effects of COPD on postoperative morbidity and mortality after CABG, and this remains to be well defined. OBJECTIVES To compare the postoperative outcomes after CABG between patients with and those without COPD. METHODS A systematic search was conducted in the Cochrane Library, PubMed, EmBase, and Ovid databases (until May 10, 2018). Studies comparing perioperative results and mortality outcomes after CABG between patients with and those without COPD were evaluated independently by 2 reviewers to identify the potentially eligible studies. Review Manager and STATA software were used for statistical analyses. RESULTS No significant difference in the mortality rates were found between patients with and those without COPD. COPD was associated with a higher respiratory failure rate (odds ratio [OR] = 4.01; 95% CI: 1.19-13.51, P = .03; P <.001 for heterogeneity), higher pneumonia rate (OR = 2.92; 95% CI: 2.37-3.60, P <.00001; P = .73 for heterogeneity), higher stroke rate (OR = 2.91; 95% CI: 1.37-6.18, P = .005; P = .60 for heterogeneity), higher renal failure rate (OR = 1.60; 95% CI: 1.30-1.97, P <.00001; P = .19 for heterogeneity), and higher wound infection rate (OR = 2.16; 95% CI: 1.21-3.88, P = .01; P = .53 for heterogeneity) after CABG. CONCLUSIONS Patients with COPD were at higher risks for developing postoperative morbidities, particularly pneumonia, respiratory failure, stroke, renal failure, and wound infection. Although COPD was not associated with a higher risk of mortality, caution should be taken when a patient with COPD is indicated for CABG, considering the higher odds of postoperative complications involving the respiratory system and others.
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Affiliation(s)
- Hui Zhao
- Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Lifang Li
- Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Guang Yang
- Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Jiannan Gong
- Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Lu Ye
- Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Shuyin Zhi
- Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Xulong Zhang
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Jianqiang Li
- Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi
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Viceconte M, Rocco IS, Pauletti HO, Vidotto M, Arena R, Gomes WJ, Guizilini S. Chronic obstructive pulmonary disease severity influences outcomes after off-pump coronary artery bypass. J Thorac Cardiovasc Surg 2018; 156:1554-1561. [PMID: 29803370 DOI: 10.1016/j.jtcvs.2018.04.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 04/05/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the impact and severity of chronic obstructive pulmonary disease (COPD) on pulmonary function and postoperative clinical outcome based on the Global Initiative for Obstructive Lung Disease criteria in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS Patients were allocated into 3 groups according to presence and severity of COPD: no or mild COPD (n = 144); moderate COPD (n = 77); and severe COPD (n = 30). Spirometry values were obtained preoperatively and on postoperative days (PODs) 2 and 5. The incidences of pneumonia and reintubation, time of mechanical ventilation, and length of postoperative hospital stay were recorded. RESULTS Significant impairment in pulmonary function was observed in all groups on PODs 2 and 5 (P < .001). However, postoperative pulmonary dysfunction was significantly higher in the moderate and severe COPD groups compared with the no or mild COPD group (P < .05). On multivariable analysis, severe COPD was associated with an elevated risk for composite outcomes (odds ratio, 1.37; 95% confidence interval, 1.20-1.57; P < .001). A preoperative forced expiratory volume in 1 second (FEV1) <50% of the predicted value was associated with poor outcome. A significant negative correlation was found between FEV1 at POD 5 and postoperative length of stay (r = -0.5; P < .001). CONCLUSIONS More severe COPD was associated with greater impairment in pulmonary function and worse clinical outcomes after off-pump CABG surgery. A preoperative FEV1 <50% of predicted value appears to be an important predictor of postoperative complications.
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Affiliation(s)
- Marcela Viceconte
- Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, Santos, Sao Paulo, Brazil; Department of Human Motion Sciences, Federal University of São Paulo, Santos, Sao Paulo, Brazil
| | - Isadora S Rocco
- Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, Santos, Sao Paulo, Brazil; Department of Human Motion Sciences, Federal University of São Paulo, Santos, Sao Paulo, Brazil
| | - Hayanne O Pauletti
- Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, Santos, Sao Paulo, Brazil; Department of Human Motion Sciences, Federal University of São Paulo, Santos, Sao Paulo, Brazil
| | - Milena Vidotto
- Department of Human Motion Sciences, Federal University of São Paulo, Santos, Sao Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Ill
| | - Walter J Gomes
- Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, Santos, Sao Paulo, Brazil
| | - Solange Guizilini
- Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, Santos, Sao Paulo, Brazil; Department of Human Motion Sciences, Federal University of São Paulo, Santos, Sao Paulo, Brazil.
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