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

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.

Does the anthropometric profile influence infection morbidity after coronary artery bypass grafting?

“…The anthropometric profile was not significantly associated with infection ( p = .12), after adjusting for possible confounders. Independent predictors of surgical site infection identified in this paper also have support in the literature, such as diabetes mellitus, 25 chronic obstructive pulmonary disease, 26 blood transfusion, 27 and obesity 28 …”

Spirometry Assessment and Correlation With Postoperative Pulmonary Complications in Cardiac Surgery Patients

“…Estimation of the ICU length of stay (LOS) is required for the successful planning of the surgical and theater facilities, for which available data needs to be analyzed. Postoperative respiratory failure and preexisting lung diseases require prolonged mechanical ventilation and lead to prolongation on ICU LOS [2][3][4]. There is a significant co-existence of cardiac and pulmonary disease and most of the patients who are candidates for cardiac surgery have preexisting pulmonary pathology.…”

A Risk Score for Predicting Long-Term Mortality Following Off-Pump Coronary Artery Bypass Grafting

“…We found that COPD, stroke history, post-operative LVEF ≤ 45%, and post-operative NLR ≥ 2.42 were independent risk factors of mortality. In a recent meta-analysis of eight clinical trials, patients with COPD undergoing CABG were at higher risk of post-operative complications, including pneumonia, respiratory failure, stroke, renal failure, and wound infection, although the short-term mortality rate was comparable between patients with and without COPD [ 19 ]. In addition, although CABG is known to have long-term beneficial effects in patients with COPD [ 20 ], more severe COPD was associated with worse clinical outcomes after OPCAB surgery [ 21 ].…”