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Morbidity associated with systemic corticosteroid preparation for coronary artery bypass grafting in patients with
Daniele Starobin1, Mordechai Rehuven Kramer, Moshe Garty
1Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. starobin@clalit.org.il
Insights
Preoperative systemic corticosteroids may reduce hospital stays for patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery bypass grafting (CABG). This treatment did not significantly alter pulmonary or nonpulmonary complication rates but improved intensive care unit (ICU) and hospital stays.
Area of Science:
- Cardiology
- Pulmonology
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) carries significant risks for patients with chronic obstructive pulmonary disease (COPD).
- The impact of preoperative systemic corticosteroids on morbidity in this high-risk population remains under investigation.
Purpose of the Study:
- To evaluate the efficacy of preoperative systemic corticosteroids in reducing postoperative morbidity in patients with COPD undergoing elective CABG.
- To compare outcomes between COPD patients receiving corticosteroids, COPD patients receiving placebo, and non-COPD control patients.
Main Methods:
- A prospective, open-label randomized trial involving 90 elective CABG candidates.
- Participants were divided into three groups: 30 COPD patients receiving a long-acting corticosteroid, 30 COPD patients receiving placebo, and 30 non-COPD controls.
- Primary endpoints included postoperative pulmonary and nonpulmonary complications; secondary endpoints assessed length of stay (LOS), ICU duration, mechanical ventilation, and functional recovery.
Main Results:
- Pulmonary complication rates were similar across all groups.
- While not statistically significant, the corticosteroid group had fewer major nonpulmonary complications than the placebo group (17% vs. 26%).
- COPD patients (treated and placebo) experienced significantly more nonpulmonary complications than non-COPD controls (70% vs. 33%). Significant reductions in ICU stay (<24 hours) and overall hospital stay were observed in the corticosteroid-treated COPD group compared to the placebo COPD group.
Conclusions:
- Preoperative systemic corticosteroid administration may be beneficial in shortening ICU and hospital stays for COPD patients undergoing CABG.
- Further research may be warranted to explore the specific mechanisms and optimize the use of corticosteroids in this patient cohort.
Background:
Coronary artery bypass grafting (CABG) is associated with high morbidity in patients with chronic obstructive pulmonary disease (COPD).We examine the effect of preoperative systemic corticosteroids on morbidity in this setting.
Methods:
Ninety candidates for elective CABG participated in a prospective, open randomized trial, including 30 patients with COPD who received a single injection of a long-acting corticosteroid, 30 with COPD who received placebo, and 30 without COPD who served as controls. Primary end-points were postoperative pulmonary and nonpulmonary complications. Secondary end-points were length of hospital stay (LOS), ICU stay of less than 24 hours and more than 48 hours, duration of mechanical ventilation, and time to walking and sitting.
Results:
The rate of pulmonary complications was similar in the two COPD groups and in the COPD patients and controls. The placebo group had more major nonpulmonary complications than the treatment group, but the difference was not statistically significant (26% vs. 17%, P = NS). The non-COPD control group had significantly fewer nonpulmonary complications than the COPD patients (treatment+placebo) (33% vs 70%, P = 0.014) and a similar rate of pulmonary complications. There was a statistically significant difference between the treated and placebo COPD groups in ICU stay less than 24 hours (P < or = 0.001) and more than 48 hours (P = 0.03) and hospital stay (P = 0.013). On stepwise analysis, only age and number of coronary grafts were predictors of pulmonary complications.
Conclusion:
The use of preoperative systemic corticosteroids in patients with COPD undergoing CABG may shorten ICU and hospital stay.
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