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Published on: September 15, 2023
Postoperative Complications After Coronary Artery Bypass Grafting in Patients With Chronic Obstructive Pulmonary
Chung-Han Ho1, Yi-Chen Chen, Chin-Chen Chu
1From the Department of Medical Research, Chi Mei Medical Center (C-HH, Y-CC, J-JW); Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science (C-HH); Department of Pharmacy, Chia Nan University of Pharmacy and Science (C-HH); Department of Anesthesiology, Chi-Mei Medical Center (C-CC); Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan (C-CC); and Department of Internal Medicine (K-ML), Chi Mei Medical Center, Chiali, Taiwan.
Insights
Patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery bypass grafting (CABG) face higher risks of pneumonia and acute respiratory failure (ARF). However, COPD did not increase 30-day mortality or acute myocardial infarction (AMI) risks post-CABG.
Area of Science:
- Cardiology
- Pulmonology
- Health Services Research
Background:
- Coronary artery disease (CAD) frequently coexists with chronic obstructive pulmonary disease (COPD).
- Previous research indicates elevated mortality risk post-coronary artery bypass grafting (CABG) for COPD patients, though studies are often limited in scope and size.
- The specific post-CABG risks of readmission, acute myocardial infarction (AMI), acute respiratory failure (ARF), cerebrovascular accident, and venous thromboembolism in Asian COPD populations require further investigation.
Purpose of the Study:
- To investigate the 30-day outcomes after CABG in Asian patients with and without chronic obstructive pulmonary disease (COPD).
- To compare rates of mortality, readmission, acute myocardial infarction (AMI), pneumonia, acute respiratory failure (ARF), cerebrovascular accident, and venous thromboembolism between COPD and non-COPD groups post-CABG.
Main Methods:
- A nationwide, population-based, propensity score-matched case-control study was conducted using Taiwan's hospitalization claims database (2009-2013).
- Patients with COPD undergoing CABG were matched with two control patients without COPD based on age, sex, and comorbidities (hypertension, diabetes, dyslipidemia, cardiovascular disease, cerebrovascular disease, chronic kidney disease).
- Outcomes assessed included 30-day mortality, wound infection, and readmission for AMI, pneumonia, ARF, cerebrovascular accident, and venous thromboembolism.
Main Results:
- The study included 758 patients with COPD and 14,858 patients without COPD who underwent CABG.
- After propensity score matching, the non-COPD group exhibited higher 30-day mortality, 30-day readmission rates, and rates of acute myocardial infarction (AMI).
- Conversely, the COPD group demonstrated significantly higher incidences of pneumonia and acute respiratory failure (ARF) following CABG.
Conclusions:
- Chronic obstructive pulmonary disease (COPD) does not appear to be an independent risk factor for increased 30-day mortality, readmission, or acute myocardial infarction (AMI) after coronary artery bypass grafting (CABG).
- The primary respiratory complications associated with CABG in patients with COPD are pneumonia and acute respiratory failure (ARF).
- These findings highlight the importance of managing respiratory risks in COPD patients undergoing CABG.
Abstract:
Coronary artery disease is common in patients with chronic obstructive pulmonary disease (COPD). Previous studies have shown that patients with COPD have a higher risk of mortality than those without COPD after coronary artery bypass grafting (CABG). However, most of the previous studies were small, single-center studies with limited case numbers (or their only focus was mortality). The aim of our study was to focus on readmission, acute myocardial infarction (AMI), acute respiratory failure (ARF), cerebrovascular accident, and venous thromboembolism rates after CABG in an Asian COPD population.We conducted a nationwide case-control study in Taiwan using the claims database of hospitalization between January 1, 2009 and December 31, 2013. Patients with COPD before CABG were defined as the case groups. Each case was propensity score-matched by age, sex, hypertension, diabetes, dyslipidemia, cardiovascular disease, cerebrovascular disease, and chronic kidney disease, with 2 controls selected from CABG patients without COPD. The outcomes of interest were mortality, wound infection, and the readmission rate over 30 days for the following diseases: AMI, pneumonia, ARF, cerebrovascular accident, and venous thromboembolism.There were 14,858 patients without COPD and 758 patients with COPD who underwent CABG. After propensity score matching, the 30-day mortality and 30-day readmission rates and AMI were higher in the non-COPD group. The incidences of pneumonia and ARF after CABG were higher in the COPD group.Chronic obstructive pulmonary disease does not necessarily lead to mortality, readmission, or AMI after CABG, and the major respiratory complications associated with CABG in patients with COPD were pneumonia and ARF.
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