Operative Risk in Patients With Severe Obstructive Pulmonary Disease

Kroenke, Kurt; Lawrence, Valerie A.; Theroux, John F.; Tuley, Michael R.

doi:10.1001/archinte.1992.00400170057011

Cited by 178 publications

(27 citation statements)

References 29 publications

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“…Respiratory complications were also included. The incidence of postoperative respiratory complications was scored on an ordinal scale of 1–4, using the operational definitions of postoperative pulmonary complications described by Kroenke et al [8] (Table 1) . Clinically significant respiratory complications were defined as one item among grade 3 or 4 complications.…”

Section: Methodsmentioning

confidence: 99%

Lung-diffusing capacity for carbon monoxide predicts early complications after cardiac surgery

et al. 2019

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Purpose Preoperative pulmonary dysfunction has been associated with increased operative mortality and morbidity after cardiac surgery. This study aimed to determine whether values for the diffusing capacity of the lung for carbon monoxide (DL CO ) could predict postoperative complications after cardiac surgery. Methods This study included 408 consecutive patients who underwent cardiac surgery between June 2008 and December 2015. DL CO was routinely determined in all patients. A reduced DL CO was clinically defined as %DL CO < 70%. %DL CO was calculated as DL CO divided by the predicted DL CO . The association between %DL CO and in-hospital mortality was assessed, and independent predictors of complications were identified by a logistic regression analysis. Results Among the 408 patients, 338 and 70 had %DL CO values of ≥ 70% and < 70%, respectively. Complications were associated with in-hospital mortality ( P < 0.001), but not %DL CO ( P = 0.275). A multivariate logistic regression analysis with propensity score matching identified reduced DL CO as an independent predictor of complications (OR, 3.270; 95%CI, 1.356–7.882; P = 0.008). Conclusions %DL CO is a powerful predictor of postoperative complications. The preoperative DL CO values might provide information that can be used to accurately predict the prognosis after cardiac surgery. Clinical trial registration number UMIN000029985.

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Section: Methodsmentioning

confidence: 99%

Lung-diffusing capacity for carbon monoxide predicts early complications after cardiac surgery

et al. 2019

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“…(Diagnostic criteria for postoperative adverse events see Supplement 1) The scoring scale (Supplement 2) has been used and continuously optimized since 1992. [6][7][8][9] Postoperative pulmonary complications were scored on a scale of 0 to 5, with 0 representing no respiratory symptoms and signs, 1 to 4 representing a gradual increase in the severity of the complications, and 5 representing death before discharge.…”

Section: Observed Parametersmentioning

confidence: 99%

<p>Effect of Intravenous Injection of Vitamin C on Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery: A Double-Blind, Randomized Trial</p>

Wang¹,

Wang²,

Zhang³

et al. 2020

DDDT

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In this study, the effect of intravenous vitamin C during surgery on the incidence of postoperative pulmonary complications (PPCs) in patients undergoing cardiopulmonary bypass and cardiac surgery was observed, and its protective effect on the lungs was evaluated to provide a reference for clinical medication. Patients and Methods: Patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) were selected. The patients were divided into group A and group C by random sequence. Patients in group A received intravenous vitamin C 1 g 10 minutes after induction of anesthesia, 10 minutes before cardiac reanimation and at the moment of sternal closure. Patients in group C were intravenously injected with the same volume of saline at the same time. The primary outcome was the postoperative pulmonary complication severity score. Other outcomes were the incidence of PPCs, awakening time, extubation time, length of ICU stay, length of hospital stay, adverse events, oxygenation index (PaO 2 /FiO 2), alveolar arterial oxygen partial pressure difference (A-aDO 2), dynamic lung compliance (Cd) and static lung compliance (Cs). Results: Seventy patients completed the study. Compared to group C, the postoperative pulmonary complication score [2(2-3) vs 2(1-2); P=0.009] and the incidence of postoperative pulmonary complications (32.43% vs 12.12%; P =0.043) were lower in group A. There were no significant differences in awakening time, extubation time, length of ICU stay, length of hospital stay, adverse events, PaO 2 /FiO 2 , A-aDO 2 , Cs, and Cd between the two groups (P>0.05). Conclusion: In summary, this small randomized trial including low-risk cardiac surgery patients shows that intravenous vitamin C may safely be administered and may be helpful to prevent PPCs after cardiac surgery.

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“…1,5,6 The identification of patientrelated features associated with increased risk for postoperative pulmonary complications (PPCs) has been reported; however, the results have been conflicting. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Surgical features that increase risk include the performance of emergent procedures; longer anesthesia duration; and the surgical incision site, with thoracic and upper abdominal incisions having the highest rate of PPCs. 2,11,15,19 Efforts have been focused on the minimization of postoperative risk factors, such as prolonged bed rest 21 and inadequate pain control, 22 and on the routine use of incentive spirometry.…”

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confidence: 99%

Multivariate Analysis of Factors Associated With Postoperative Pulmonary Complications Following General Elective Surgery

Mitchell

Smoger²,

Pfeifer³

et al. 1998

Arch Surg

156

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To develop a predictive model identifying perioperative conditions associated with postoperative pulmonary complications (PPCs).Design: A prospective survey of patients whose preoperative history and physical examination, spirometric, PaO 2 and PaCO 2 analysis, and operative results were recorded. These patients underwent postoperative cardiopulmonary examinations until they were discharged from the hospital; their medical records were also reviewed until they were discharged from the hospital.

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Operative Risk in Patients With Severe Obstructive Pulmonary Disease

Abstract: Although the risk of coronary artery bypass grafting deserves further study, noncardiac surgery carries an acceptable operative risk in patients with severe chronic obstructive pulmonary disease.

Cited by 178 publications

References 29 publications

Lung-diffusing capacity for carbon monoxide predicts early complications after cardiac surgery

Lung-diffusing capacity for carbon monoxide predicts early complications after cardiac surgery

<p>Effect of Intravenous Injection of Vitamin C on Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery: A Double-Blind, Randomized Trial</p>

Multivariate Analysis of Factors Associated With Postoperative Pulmonary Complications Following General Elective Surgery

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