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Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease
Jimmy T Efird1, William Griffin1, Wesley T O'Neal2
1Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University.
Insights
Prolonged length of stay (PLOS) after coronary artery bypass grafting (CABG) significantly reduces long-term survival, especially for patients with chronic obstructive pulmonary disease (COPD). Early interventions are crucial for improving outcomes.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Medicine
- Health Services Research
Background:
- Chronic Obstructive Pulmonary Disease (COPD) patients often experience prolonged length of stay (PLOS) after Coronary Artery Bypass Grafting (CABG).
- The impact of PLOS on long-term survival in COPD patients post-CABG remains under-examined.
Purpose of the Study:
- To determine the association between PLOS and long-term survival in COPD and non-COPD patients post-CABG.
- To explore policy and practice implications for managing these patient populations.
Main Methods:
- Retrospective cohort study of 4801 CABG patients (2002-2011).
- Comparison of long-term survival stratified by COPD status and PLOS.
- Cox regression analysis to compute Hazard Ratios (HR) and 95% Confidence Intervals (CI).
Main Results:
- PLOS independently predicted decreased long-term survival.
- Patients with both COPD and PLOS had the highest mortality risk (adjusted HR: 6.0 [95% CI, 4.4-8.2]).
- A significant trend (P < .001) showed increasing mortality with both COPD and PLOS.
Conclusions:
- COPD and PLOS are critical independent predictors of long-term mortality post-CABG.
- Strategies for early mechanical ventilation weaning and reintubation prevention in COPD patients are vital to reduce PLOS.
- Findings inform long-term patient management and cost-containment strategies.
Background:
Although many patients with chronic obstructive pulmonary disease (COPD) require a prolonged length of stay (PLOS) following coronary artery bypass grafting (CABG), the impact of PLOS on long-term survival has not been examined in this population.
Objectives:
To determine the association between PLOS and long-term survival among COPD and non-COPD patients after CABG and to examine consequent policy and practice-based implications.
Methods:
A retrospective cohort study of CABG patients was conducted between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by PLOS. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model.
Results:
A total of 203 patients (4.2%) had PLOS after nonemergent CABG (N = 4801). PLOS was an important independent predictor of decreased long-term survival (no COPD, no PLOS: HR = 1.0; COPD, no PLOS: adjusted HR [95% CI], 1.8 [1.5-2.1]; no COPD, PLOS: 3.3 [2.5-4.4]; COPD, PLOS: 6.0 [4.4-8.2]; PTrend < .001).
Conclusions:
COPD and PLOS are 2 of many factors that affect long-term mortality in postoperative CABG patients. Aggressive treatment strategies aimed at early weaning off of mechanical ventilation and prevention of reintubation among COPD patients must be considered carefully as a means to reduce length of stay after CABG. Our results also have important implications for the long-term management of these patients and strategies for containing costs over the life course of the patient.
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