Chest
Volume 104, Issue 5, November 1993, Pages 1445-1451
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Clinical Investigations: Cardiology Cardio-Thoracic Surgery: Comparative Study: Journal Article
Postoperative Complications After Thoracic and Major Abdominal Surgery in Patients With and Without Obstructive Lung Disease

https://doi.org/10.1378/chest.104.5.1445Get rights and content

Study objective

To determine the risk of thoracic and major abdominal surgery in patients with chronic obstructive pulmonary disease (COPD).

Design

Retrospective cohort study with controls.

Setting

A 692-bed teaching hospital.

Patients

A cohort of 26 patients with severe COPD (FEV1 <50 percent predicted) undergoing thoracic and major abdominal surgery was matched by age and type of operation to 52 patients with mild-moderate COPD and 52 patients with no COPD.

Measurements and results

The 26 patients with severe COPD had rates of cardiac, vascular, and minor pulmonary complications similar to patients with mild-moderate COPD and without COPD, but experienced higher rates of serious pulmonary complications (23 percent vs 10 percent vs 4 percent, p = 0.03) and death (19 percent vs 4 percent vs 2 percent, p = 0.02). All deaths and instances of ventilatory failure in the patients with severe COPD occurred in the subset undergoing coronary artery bypass surgery. Logistic regression revealed that increased age, higher American Society of Anesthesiologists class, an abnormal chest radiograph, and perioperative bronchodilator administration were associated with higher cardiac or serious pulmonary complication rates. Spirometry was not an independent predictor of postoperative complications.

Conclusions

Clinical variables appear better than preoperative spirometry in predicting postoperative cardiopulmonary complications. The utility of preoperative spirometry as well as the benefits of perioperative bronchodilators in patients in stable condition remain to be determined.

Section snippets

Methods

The study site was Brooke Army Medical Center, a 692-bed teaching hospital in Texas that serves active-duty and retired military personnel and their dependents. From 107 elective operations performed in patients with severe COPD at Brooke between January 1986 and September 1988,17 we focused on the 31 nonresectional thoracic and major abdominal procedures. In 26 of these, we had complete hospital records and for 5, detailed narrative summaries. These latter five patients had been transferred

Postoperative Complications

Operative outcome is summarized in Table 2. Patients with severe COPD were more likely to experience bronchospasm (p = 0.002) and supraventricular tachyarrhythmias (p = 0.01). However, the frequency of most individual complications was too low for the differences to reach statistical significance, so complications were grouped and analyzed by category. Rates of minor pulmonary (grade 1 or 2), cardiac, and vascular complications were similar among study groups. Vascular complications consisted

Discussion

In patients undergoing thoracic and major abdominal operations, COPD was associated with an increased risk of serious pulmonary complications and death. On the other hand, severity of COPD did not affect the incidence of the more frequent cardiac and low-grade pulmonary complications. Spirometry per se was not an independent predictor, whereas the clinical variables of higher ASA class, increasing age, abnormal chest radiograph, and bronchodilator administration were significantly associated

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    The opinions or assertions herein are the private views of the author and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

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