Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background Although many patients with chronic obstructive pulmonary disease (COPD) require a prolonged length of stay (PLOS) following coronary artery bypass grafting (CABG), the impact of PLOS on long-term survival has not been examined in this population. Objectives To determine the association between PLOS and long-term survival among COPD and non-COPD patients after CABG and to examine consequent policy and practice-based implications. Methods A retrospective cohort study of CABG patients was conducted between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by PLOS. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Conclusions COPD and PLOS are 2 of many factors that affect long-term mortality in postoperative CABG patients. Aggressive treatment strategies aimed at early weaning off of mechanical ventilation and prevention of reintubation among COPD patients must be considered carefully as a means to reduce length of stay after CABG. Our results also have important implications for the long-term management of these patients and strategies for containing costs over the life course of the patient.

Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery

“…Considering pulmonary-related morbidity, the present study found that COPD increased the risk of postoperative pneumonia and respiratory failure. This result was in agreement with the study conducted by Ried et al [27] In the study by Samuels et al [9] the pneumonia rate was also found to be more prominent for patients with COPD after cardiac surgery. The underlying mechanism may be that patients with COPD usually develop a differential inflammatory response with increased release of cysteinyl leukotrienes during cardiac surgery, which could lead to potential small airway dysfunction.…”

“…The result of myocardial infarction in the present study was in contrast with that reported by Efird et al's study in which no significant difference was found on postoperative myocardial infarction rates between patients with and without COPD. [27] Although scores of both Begg and Egger tests on myocardial infarction showed no publication bias, this results could be limited by the small number of the studies included. Moreover, according to the funnel plot analysis, 1 study was in the non-significant areas.…”

“…These results were in agreement with the study conducted by Efird et al, in which patients with COPD were also found to present with a higher rate of renal failure and stroke than patients without COPD. [27] Rodrigues et al also confirmed that COPD was an independent risk factor for renal failure after cardiac surgery. [32] Another significant difference between patients with and those without COPD was found in terms of wound infection.…”

<p>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</p>

“…Results from other studies were not consistent in this issue. Efird et al 21 found that COPD was a risk factor of long-term survival after coronary artery bypass grafting surgery with a HR of 1.8, while Manganas et al 22 concluded that mortality associated with coronary artery bypass grafting surgery was not influenced by COPD. Another result that needs to be discussed was the inverse association between comorbid COPD and ICU mortality for SICU patients, which seems counter-intuitive.…”

Chronic obstructive pulmonary disease as a predictor of unfavourable prognosis in patients after myocardial revascularization

“…Согласно ранее проведенным исследованиям убедительно доказано, что коронарное шунтирование (КШ) улучшает качество жизни и продлевает жизнь пациентов с ишемической болезнью сердца (ИБС). Однако результаты исследований, посвященных влиянию коморбидной патологии, а именно хронической обструктивной болезни легких (ХОБЛ), на долгосрочный прогноз у данной категории пациентов, противоречивы [1][2][3][4][5]. Кроме того, основной задачей этих исследований явился анализ показателей смертности.…”