Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
Eur J Cardiothorac Surg. 2012 Jul;42(1):108-13; discussion 113. doi: 10.1093/ejcts/ezr271. Epub 2012 Jan 22.
Although the association between chronic obstructive pulmonary disease (COPD) and adverse surgical outcomes has been previously demonstrated, the impact of COPD severity on postoperative mortality and morbidity remains unclear. Our objective was to analyse the prognostic implication of COPD stages as defined by the Global Initiative for Chronic Obstructive Lung Disease.
Between September 1997 and April 2010, 13,638 patients undergoing first time isolated CABG were retrospectively reviewed, of whom 2421 patients were excluded due to lack of spirometry records or restrictive pattern on spirometry. The remaining 11,217 patients were divided into three groups: group 1 (including patients with normal spirometry and patients with mild COPD (FEV1/FVC ratio<70%, FEV1≥80% predicted), group 2 (moderate COPD: FEV1/FVC ratio<70%, 50%≤FEV1<80% predicted) and group 3 (severe COPD: FEV1/FVC ratio<70%, FEV1<50% predicted). Logistic regression was used to examine the effect of COPD severity on early mortality and morbidity, after adjusting for differences in patient characteristics.
Early mortality in the three groups was 1.4, 2.9 and 5.7% respectively (P<0.001). Similarly, a consistent trend of increasing frequency of postoperative complications with advanced COPD stage was noted. On multivariate analysis, severe COPD was found to be significantly associated with early mortality [adjusted OR, 2.31 (95% CI) (1.23-4.36)], P=0.01.
The severity of COPD as defined by spirometry can be a prognostic marker in patients undergoing CABG. Spirometric criteria may help refining currently used operative risk scores.
虽然慢性阻塞性肺疾病（COPD）与不良手术结果之间存在关联，但 COPD 严重程度对术后死亡率和发病率的影响仍不清楚。我们的目的是分析全球慢性阻塞性肺疾病倡议（GOLD）定义的 COPD 分期对预后的影响。
1997 年 9 月至 2010 年 4 月，回顾性分析了 13638 例首次接受单纯冠状动脉旁路移植术（CABG）的患者，其中 2421 例因缺乏肺量计记录或肺量计呈限制模式而被排除。剩余的 11217 例患者被分为三组：第 1 组（包括肺量计正常和轻度 COPD 患者（FEV1/FVC 比<70%，FEV1≥80%预计值），第 2 组（中度 COPD：FEV1/FVC 比<70%，50%≤FEV1<80%预计值）和第 3 组（重度 COPD：FEV1/FVC 比<70%，FEV1<50%预计值）。使用逻辑回归检查 COPD 严重程度对早期死亡率和发病率的影响，调整患者特征差异后。
三组患者的早期死亡率分别为 1.4%、2.9%和 5.7%（P<0.001）。同样，随着 COPD 分期的进展，术后并发症的发生频率也呈增加趋势。多变量分析发现，重度 COPD 与早期死亡率显著相关[校正比值比，2.31（95%CI）（1.23-4.36），P=0.01]。
肺量计定义的 COPD 严重程度可作为 CABG 患者的预后标志物。肺量计标准可能有助于完善目前使用的手术风险评分。
