Clinical InvestigationSurgeryPreoperative pulmonary function and mortality after cardiac surgery
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)
- et al.
Risk factors for intermediate-term survival after coronary artery bypass grafting
Ann Thorac Surg
(2001) - et al.
Variation in mortality risk factors with time after coronary artery bypass graft operation
Ann Thorac Surg
(2003) - et al.
Coronary artery bypass grafting in patients with COPD
Chest
(1998) - et al.
Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease
Chest
(1993) - et al.
Risk factors for nosocomial pneumonia after coronary artery bypass graft operations
Ann Thorac Surg
(1991) - et al.
Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting
Am J Cardiol
(2001) - et al.
Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery
Ann Thorac Surg
(1990) - et al.
Spirometry utilization for COPD: how do we measure up?
Chest
(2007) - et al.
Spirometry use in clinical practice following diagnosis of COPD
Chest
(2006) - et al.
Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD
Chest
(2007)
Attaining a correct diagnosis of COPD in general practice
Respir Med
The Veterans Affairs Continuous Improvement in Cardiac Surgery Study
Ann Thorac Surg
Prognostic significance of elevated cardiac troponin I after heart surgery
Ann Thorac Surg
Long-term beneficial effect of coronary artery bypass grafting in patients with COPD
Chest
Associations between reduced diffusing capacity and airflow obstruction in community-based subjects
Respir Med
Pulmonary diffusing capacity in left ventricular dysfunction
Chest
Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study
Chest
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