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Published on: March 27, 2018
Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass
Hui Zhao1, Lifang Li1, Guang Yang1
1Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi.
Insights
Patients with chronic obstructive pulmonary disease (COPD) face higher risks of complications like pneumonia and respiratory failure after coronary artery bypass grafting (CABG) surgery. However, COPD does not significantly increase the risk of mortality following CABG.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients undergoing coronary artery bypass grafting (CABG).
- Historically, COPD was a contraindication for CABG, but advancements have made the procedure more feasible.
- The impact of COPD on postoperative outcomes after CABG requires further clarification.
Purpose of the Study:
- To systematically compare postoperative outcomes and mortality rates in patients who underwent CABG, with or without COPD.
Main Methods:
- A systematic literature search was performed across major databases (Cochrane Library, PubMed, EmBase, Ovid) until May 2018.
- Studies comparing perioperative results and mortality between CABG patients with and without COPD were independently reviewed.
- Statistical analyses were conducted using Review Manager and STATA software.
Main Results:
- No significant difference in mortality rates was observed between patients with and without COPD.
- COPD was associated with significantly higher rates of respiratory failure (OR=4.01), pneumonia (OR=2.92), stroke (OR=2.91), renal failure (OR=1.60), and wound infection (OR=2.16).
- Significant heterogeneity was noted for respiratory failure, but not for other complications.
Conclusions:
- Patients with COPD undergoing CABG have an increased risk of specific postoperative morbidities, including respiratory and wound infections, and renal failure.
- While mortality risk is not elevated, heightened vigilance for complications is crucial in COPD patients undergoing CABG.
- The findings underscore the importance of managing respiratory and other potential complications in this patient population.
Introduction:
Chronic obstructive pulmonary disease (COPD) is a frequent comorbid disease in patients undergoing coronary artery bypass grafting (CABG) surgery, with an incidence ranging from 4% to 20.5%. Conventionally, COPD was recognized as a surgical contraindication to CABG. Because of the recent improvements in surgical techniques, anesthesia, and postoperative management, CABG has been performed more commonly in patients with COPD. However, studies have shown the various effects of COPD on postoperative morbidity and mortality after CABG, and this remains to be well defined.
Objectives:
To compare the postoperative outcomes after CABG between patients with and those without COPD.
Methods:
A systematic search was conducted in the Cochrane Library, PubMed, EmBase, and Ovid databases (until May 10, 2018). Studies comparing perioperative results and mortality outcomes after CABG between patients with and those without COPD were evaluated independently by 2 reviewers to identify the potentially eligible studies. Review Manager and STATA software were used for statistical analyses.
Results:
No significant difference in the mortality rates were found between patients with and those without COPD. COPD was associated with a higher respiratory failure rate (odds ratio [OR] = 4.01; 95% CI: 1.19-13.51, P = .03; P <.001 for heterogeneity), higher pneumonia rate (OR = 2.92; 95% CI: 2.37-3.60, P <.00001; P = .73 for heterogeneity), higher stroke rate (OR = 2.91; 95% CI: 1.37-6.18, P = .005; P = .60 for heterogeneity), higher renal failure rate (OR = 1.60; 95% CI: 1.30-1.97, P <.00001; P = .19 for heterogeneity), and higher wound infection rate (OR = 2.16; 95% CI: 1.21-3.88, P = .01; P = .53 for heterogeneity) after CABG.
Conclusions:
Patients with COPD were at higher risks for developing postoperative morbidities, particularly pneumonia, respiratory failure, stroke, renal failure, and wound infection. Although COPD was not associated with a higher risk of mortality, caution should be taken when a patient with COPD is indicated for CABG, considering the higher odds of postoperative complications involving the respiratory system and others.
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