Preoperative Assessment of Pulmonary Function Tests and Outcomes After Cardiac Surgery
Keywords:pulmonary function test, chronic lung disease, cardiac surgery, spirometry
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.
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.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).