Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease.
Am J Crit Care
; 25(3): 266-76, 2016 05.
Article
em En
| MEDLINE
| ID: mdl-27134234
ABSTRACT
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Ponte de Artéria Coronária
/
Doença Pulmonar Obstrutiva Crônica
/
Cardiopatias
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article