Preoperative Assessment of Pulmonary Function Tests and Outcomes After Cardiac Surgery
DOI:
https://doi.org/10.1532/hsf.2791Keywords:
pulmonary function test, chronic lung disease, cardiac surgery, spirometryAbstract
Background: To investigate the association between preoperative pulmonary function evaluations and surgical outcomes of patients with chronic lung disease following cardiac surgery.
Methods: This retrospective observational study evaluated 148 patients using preoperative pulmonary function tests before undergoing cardiac surgery. Patients were divided into 4 groups (normal, obstructive, restrictive, and combined disorder), based on the result of the pulmonary function tests. Additionally, we evaluated the percent predicted forced expiratory volume in 1 second. Finally, we investigated the mechanical ventilation duration, length of postoperative hospital stay, and the 30-day mortality rate between the groups in each study.
Results: The mechanical ventilation duration and length of postoperative hospital stay in the combined group was significantly longer than that in the other groups (P < .0001,
P < .0001, respectively). Patients in the restrictive group had a significantly longer postoperative ventilation or hospitalization than those in the normal group (P = .0479, P = .0164, respectively). However, there were no significant differences in the 30-day mortality rates between the groups. There also was a significant negative correlation between the percent predicted forced expiratory volume in 1 second and mechanical ventilation (R2 = 0.052, P = .0054) and postoperative hospitalization (R2 = 0.042, P = .0122).
Conclusion: Risk stratification by preoperative pulmonary function tests may be used to accurately identify the postoperative outcomes in chronic lung disease patients following cardiac surgery.
References
Ad N, Henry L, Halpin L, et al. 2010. The use of spirometry testing prior to cardiac surgery may impact the Society of Thoracic Surgeons risk prediction score: a prospective study in a cohort of patients at high risk for chronic lung disease. J Thorac Cardiovasc Surg 139:686–91.
Adabag AS, Wassif HS, Rice K, et al. 2010. Preoperative pulmonary function and mortality after cardiac surgery. Am Heart J 159:691–7.
Celli BR, MacNee W, ATS/ERS Task Force. 2004. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 23:932–46.
Cohen AJ, Katz MG, Frenkel G, et al. 2000. Morbid results of prolonged intubation after coronary artery bypass surgery. Chest 118:1724–31.
Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. 2008. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest 133:713–21.
Henn MC, Zajarias A, Lindman BR, et al. 2016. Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 151:578–85.
Hulzebos EH, Helders PJ, Favié NJ, et al. 2006. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA 296:1851–7.
Ivanov A, Yossef J, Tailon J, et al. 2016. Do pulmonary function tests improve risk stratification before cardiothoracic surgery? J Thorac Cardiovasc Surg 151:1183–9.
Lang PO, Michel JP, Zekry D. 2009. Frailty syndrome: a transitional state in a dynamic process. Gerontology 55:539–49.
Magee MJ, Herbert MA, Roper KL, et al. 2013. Pulmonary function tests overestimate chronic pulmonary disease in patients with severe aortic stenosis. Ann Thorac Surg 96:1329–35.
Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC. 2003. Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax 58:388–93.
Miyata H, Tomotaki A, Motomura N, Takamoto S. 2015. Operative mortality and complication risk model for all major cardiovascular operations in Japan. Ann Thorac Surg 99:130–9.
Roques F, Nashef SA, Michel P, et al. 1999. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816–22.
Saleh HZ, Mohan K, Shaw M, et al. 2012. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur J Cardiothorac Surg 42:108–13.
Saleh HZ, Shaw M, Al-Rawi O, et al. 2012. Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery. Interact Cardiovasc Thorac Surg 15:51–6.
Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK. 1998. Coronary artery bypass grafting in patients with COPD. Chest113:878–82.
Shroyer AL, Coombs LP, Peterson ED, et al. 2003. The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg 75:1856–64.
Snowdon D, Haines TP, Skinner EH. 2014. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review. J Physiother 60:66–77.
Vaz Fragoso CA, Enright PL, McAvay G, Van Ness PH, Gill TM. 2012. Frailty and respiratory impairment in older persons. Am J Med 125:79–86.
Zanini M, Nery RM, Buhler RP, de Lima JB, Stein R. 2016. Preoperative maximal expiratory pressure is associated with duration of invasive mechanical ventilation after cardiac surgery: An observational study. Heart Lung 45:244–8.
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