Clinical Investigation
Surgery
Preoperative pulmonary function and mortality after cardiac surgery

https://doi.org/10.1016/j.ahj.2009.12.039Get rights and content

Background

The aim of the study was to examine the relationship between preoperative pulmonary function and outcomes after cardiac surgery.

Methods

We performed preoperative pulmonary function tests (PFTs) in 1,169 patients undergoing cardiac surgery at the Minneapolis Veterans Affairs Medical Center. Airway obstruction was defined as forced expiratory volume in 1 minute (FEV1) to forced vital capacity ratio <0.7.

Results

Of the 1,169 patients, 483 (41%) had a prior history of chronic obstructive pulmonary disease (COPD). However, 178 patients with a history of COPD had no airway obstruction on PFT. Conversely, 186 patients without a COPD history had airway obstruction on PFT. Thus, PFT results helped reclassify the COPD status of 364 patients (31%). Operative mortality was 2% in patients with no or mild airway obstruction versus 6.7% in those with moderate or severe obstruction (ie, FEV1 to forced vital capacity ratio <0.7 and FEV1 <80% predicted). Postoperative mortality was higher (odds ratio 3.2, 95% CI 1.6-6.2, P = .001) in patients with moderate or severe airway obstruction and in patients with diffusing capacity of the lung for carbon monoxide <50% of predicted (odds ratio 4.9, 95% CI 2.3-10.8, P = .0001). Notably, mortality risk was 10× higher (95% CI 3.4-27.2, P = .0001) in patients with moderate or severe airway obstruction and diffusing capacity of the lung for carbon monoxide <50% of predicted.

Conclusions

These data show that PFT before cardiac surgery reclassifies the COPD status of a substantial number of patients and provides important prognostic information that the current risk estimate models do not capture.

Section snippets

Methods

This study was approved by the research and development committee of Minneapolis Veterans Affairs (VA) Medical Center, and the requirement for individual consent was waived.

No extramural funding was used to support this work. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.

Baseline characteristics

The baseline characteristics of the 1,169 cardiac surgery patients with PFT are outlined in Table II. Patients were 67 ± 10 years in age, and 99% were male. A significant minority (n = 483, 41%) had a history of COPD. However, 178 patients with a prior history of COPD had no airway obstruction on PFT. Conversely, 186 patients without a prior COPD history had airway obstruction on PFT (ie, FEV1/FVC <0.7). Thus, after the PFT results, a total of 364 patients (31%) were reclassified with regard to

Discussion

The purpose of this investigation was to correlate a clinical history of COPD with the results of PFT and examine the relation between the preoperative pulmonary function and outcomes after cardiac surgery. Our data showed that preoperative PFTs, performed in a large cohort of patients before cardiac surgery, helped reclassify the COPD status of >30% of the patients. Furthermore, moderate or severe airway obstruction and reduction in DLCO (ie, <50% of predicted) were each independently

Disclosures

Author contributions:

Selcuk Adabag: conception and design, analysis and interpretation of data, drafting the article, and final approval.

Heba S. Wassif: acquisition of data, analysis and interpretation of data, drafting the article, and final approval.

Kathryn Rice: conception and design, analysis and interpretation of data, revision of the manuscript for critical and important intellectual content, and final approval.

Salima Mithani: acquisition of data, analysis and interpretation of data,

Acknowledgements

We are indebted to Kathrine K Apple, BS, for collection of data.

References (34)

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