The Obstructive and Restrictive Spirometry Pattern and Post-Cardiac Surgery Pulmonary Complications

Document Type : Original Article

Authors

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Objectives: We sought to determine the frequency of postoperative pulmonary complications (PPCs) after cardiac surgeries in patients with obstructive, restrictive, and normal spirometry tests.
 
Methods: This cohort study enrolled 623 patients who underwent cardiac surgeries at Rajaie Cardiovascular Medical and Research Center between 2017 and 2018 in 3 groups: obstructive, restrictive, and normal. The incidence of PPCs and their risk factors were noted. Associations between the incidence of PPCs and spirometry patterns and preoperative and intraoperative risk factors were evaluated statistically.
 
Results: Among all the PPCs evaluated in the patients, pulmonary edema/acute respiratory distress syndrome was much less common in the group with obstructive airflow limitations than in the groups with restrictive or normal lung patterns (P=0.010). The frequencies of other PPCs were not statistically significantly different between the 3 study groups (P>0.05). Among all the evaluated outcomes, the mean ventilation time was statistically different between the groups (P=0.059). Additionally, the incidence rate of pulmonary edema/acute respiratory distress was statistically significantly higher in the group with restrictive airflow limitations than in the other 2 groups. Operative mortality occurred in 15 cases (2.4%), and there were no significant differences in outcomes between the group with PPCs and those without them (P>0.05).
 
Conclusions: Whereas there were no statistically significant differences concerning PPCs and in-hospital outcomes between the groups with obstructive, restrictive, and normal lung patterns, the 3 groups were meaningfully different regarding the estimated glomerular filtration rate, diabetes, thyroid-stimulating hormone, and history of morning fatigue. (Iranian Heart Journal 2024; 25(2): 65-74)

Keywords

References

  1. Bapoje SR, Whitaker JF, Schulz T, Chu ES, Albert RK. Preoperative evaluation of the patient with pulmonary disease. Chest. 2007; 132(5):1637-45.
  2. Aslam J, Vallurupalli S, Kelil A, White P. Outcomes After Coronary Artery Bypass Grafting in Patients With Restrictive Spirometry Pattern. Chest. 2010; 138(4):473A.
  3. Patel NM, Kulkarni T, Dilling D, Scholand MB, Gupta N, Strek M, et al. Preoperative Evaluation of Patients With Interstitial Lung Disease. Chest. 2019; 156(5):826-33.
  4. Lawrence VA, Page CP, Harris GD. Preoperative spirometry before abdominal operations: a critical appraisal of its predictive value. Archives of internal medicine. 1989; 149(2):280-5.
  5. Sadeghi HA, Tabrizi RA, Ghadrdoost B, Azarfarin R. Evaluation of pulmonary complications in patients with valvular heart surgery: Clinical and laboratory significances. Res Cardiovasc Med. 2017; 6(2):e39944-e.
  6. Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck S. Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest. 1993; 104(5):1445-51.
  7. Jeong B-H, Shin B, Eom JS, Yoo H, Song W, Han S, et al. Development of a prediction rule for estimating postoperative pulmonary complications. PloS one. 2014; 9(12).
  8. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2010; 113(6):1338-50.
  9. Mazo V, Sabaté S, Canet J, Gallart L, de Abreu MG, Belda J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2014; 121(2):219-31.
  10. Rock P, Rich PB. Postoperative pulmonary complications. Current Opinion in Anesthesiology. 2003; 16(2):123-31.
  11. Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleveland Clinic journal of medicine. 2009; 76(4):S60.
  12. Younossian A, Adler D, Bridevaux P, Kherad O. Postoperative pulmonary complications: how to anticipate and prevent the risk? Revue medicale suisse. 2011; 7(317):2214, 6-9.
  13. Sachdev G, Napolitano LM. Postoperative pulmonary complications: pneumonia and acute respiratory failure. Surgical Clinics. 2012; 92(2):321-44.
  14. Chumillas S, Ponce J, Delgado F, Viciano V, Mateu M. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Archives of physical medicine and rehabilitation. 1998; 79(1):5-9.
  15. Magovern JA, Sakert T, Magovern GJ, Benckart DH, Burkholder JA, Liebler GA. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. Journal of the American College of Cardiology. 1996; 28(5):1147-53.
  16. Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients: a clinical severity score. Jama. 1992; 267(17):2344-8.
  17. Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK. Coronary artery bypass grafting in patients with COPD. Chest. 1998; 113(4):878-82.
  18. Michalopoulos A, Geroulanos S, Papadimitriou L, Papadakis E, Triantafillou K, Papadopoulos K, et al. Mild or moderate chronic obstructive pulmonary disease risk in elective coronary artery bypass grafting surgery. World journal of surgery. 2001; 25(12):1507-11.
  19. Angouras DC, Anagnostopoulos CE, Chamogeorgakis TP, Rokkas CK, Swistel DG, Connery CP, et al. Postoperative and long-term outcome of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting. The Annals of thoracic surgery. 2010; 89(4):1112-8.
Iranian Heart Journal
Volume 25, Issue 2
March 2024
Pages 65-74

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