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Is chronic obstructive pulmonary disease an independent risk factor for transfusion in coronary artery bypass graft
Lacey M Stelle1, Theresa M Boley, Stephen J Markwell
1Southern Illinois University School of Medicine, Springfield, IL, USA.
Insights
Chronic obstructive pulmonary disease (COPD) does not increase the risk of blood transfusion during coronary artery bypass graft (CABG) surgery. Objective pulmonary function tests confirm that even severe COPD does not predict transfusion needs in CABG patients.
Area of Science:
- Cardiology
- Pulmonology
- Anesthesiology
Background:
- The association between chronic obstructive pulmonary disease (COPD) and blood product transfusion during coronary artery bypass graft (CABG) surgery is debated.
- Previous studies lack objective criteria for defining COPD, leading to inconsistent findings.
Purpose of the Study:
- To investigate the role of COPD, defined by objective pulmonary function test (PFT) data, as a risk factor for blood transfusion in CABG patients.
- To clarify conflicting literature regarding COPD and transfusion requirements in CABG.
Main Methods:
- 180 patients undergoing primary, isolated, non-emergent CABG with preoperative PFTs were analyzed.
- COPD was defined using FEV1/FVC <70% and stratified by GOLD guidelines.
- Patients with and without COPD were compared for preoperative/postoperative characteristics and transfusion rates.
Main Results:
- The overall transfusion rate was 59.4%.
- COPD patients were older, had lower BMI, and were more often smokers, but had shorter cardiopulmonary bypass times.
- Transfusion rates were similar between COPD and non-COPD groups, irrespective of COPD severity.
Conclusions:
- Objective PFT data demonstrate that COPD is not a significant risk factor for blood transfusion during CABG.
- Pulmonary function, even in severe COPD, does not predict the need for transfusion in this patient population.
Objective:
The literature is inconsistent regarding the role of chronic obstructive pulmonary disease (COPD) as a risk factor for blood product transfusion during coronary artery bypass graft (CABG). One reason may be lack of objective criteria to define COPD in previously published reports. We examined the role of COPD as a risk factor for transfusion using a strict definition based on objective pulmonary function test (PFT) data.
Methods:
We identified 180 patients, who underwent primary isolated non-emergent CABG and had PFTs performed preoperatively. COPD was defined as forced expiratory volume in 1s/forced vital capacity (FEV1/FVC) <70% and further stratified into mild/moderate/severe/very severe based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Patients with and without COPD were compared with respect to preoperative and postoperative characteristics and transfusion requirements.
Results:
The overall transfusion rate was 59.4% (107/180). COPD patients (31.1%, 56/180) were older (66.6 ± 11.4 vs 62.3 ± 10.3 years, p = 0.01), had lower body mass index (BMI) (28.5 ± 5.8 vs 31.7 ± 6.0 kg/m(2), p=0.001), and were more often smokers (51.8% vs 36.3%, p = 0.05). COPD patients had shorter cardiopulmonary bypass (CPB) times (99.4 ± 27.9 vs 110.9 ± 32.4 min, p = 0.02), but left internal mammary artery (LIMA) use, number of bypass grafts, mortality, and postoperative complications were similar (p > 0.05). Transfusion rates were similar for patients with and without COPD. Further stratification into mild/moderate/severe/very severe COPD failed to identify COPD as a predictor of blood transfusion.
Conclusions:
Using objective PFT data, our study clarifies the disagreement in the literature with respect to the role of COPD as a risk factor for transfusion in CABG. Decreased pulmonary function does not appear to increase risk of transfusion during CABG, even for patients with severe COPD.
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