Preoperative Lung Function Assessment and the Impact of Spirometry Misdiagnosis on Mortality Following Cardiac
Robert Peat1, Thomas Simon FitzMaurice2, Freddy Frost3
1Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.
Objectives:
Individuals undergoing cardiac surgery often have obstructive lung disease. This may affect surgical mortality, but a pre-existing diagnosis may not be present in all individuals with obstruction. The objectives of this study were to describe the relationship between obstructive spirometry and cardiothoracic surgery outcomes in those with and without a preoperative diagnosis of respiratory disease.
Design:
Retrospective, observational, noncontrolled.
Setting:
Single-center, tertiary cardiothoracic teaching hospital.
Participants:
A total of 16,906 consecutive patients undergoing preoperative spirometry between January 2010 and September 2020.
Interventions:
Preoperative spirometry prior to cardiac surgery.
Measurements And Main Results:
The median (interquartile range) age of participants was 69 (61, 75) years, and 28.4% were female. Overall, 3,284 (19.4%) had a documented history of lung disease, and 4,712 (27.9%) demonstrated obstruction on spirometry. Of those without a diagnosis of respiratory disease, 3,672 (21.7%) were found to demonstrate obstructive spirometry and were considered "diagnosis-/obstruction+." Of those with a diagnosis of chronic obstructive pulmonary disease, 568 (39.2%) did not demonstrate a pattern of obstruction on spirometry and were considered "diagnosis+/obstruction-." In-hospital mortality was highest in the diagnosis+/obstruction+ (4.5%) and diagnosis+/obstruction- (3.8%) groups, and lowest in the diagnosis-/obstruction+ (2.6%) and diagnosis-/obstruction- (1.8%) groups.
Conclusions:
A significant proportion of patients undergoing cardiac surgery have obstructive spirometry, many of whom have no diagnosis of respiratory disease. Mis- or undiagnosed obstructive disease may impact in-hospital mortality. Preoperative spirometry offers opportunities for case finding, disease reclassification, and treatment optimization.
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