Optimizing Patients With Chronic Obstructive Pulmonary Disease Preoperatively May Reduce Complications and Improve Outcomes in Infrainguinal Endovascular Revascularization.
Renxi Li, Rachel Silverman, Anton Sidawy, Bao-Ngoc Nguyen
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引用次数: 0
Abstract
Background: Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are both systemic inflammatory diseases that may share similar pathophysiological pathways. Given their potential overlap, the impact of COPD on perioperative outcomes following infrainguinal endovascular revascularization warrants further examination. Therefore, this study aimed to analyze the 30-day postoperative outcomes for COPD patients after infrainguinal endovascular revascularization.
Methods: Chronic obstructive pulmonary disease and non-COPD patients who underwent infrainguinal endovascular revascularization were identified in the ACS-NSQIP database from 2012 to 2022. Exclusion criteria included aged less than 18 years and emergency cases. A 1:1 propensity-score matching was used to match demographics, baseline characteristics, symptomatology, and anesthesia. Thirty-day postoperative outcomes were compared.
Results: Of 24 223 patients who underwent infrainguinal endovascular revascularization, 2472 (10.21%) had COPD. All COPD patients were 1:1 propensity-score-matched to the non-COPD patients. Chronic obstructive pulmonary disease patients had higher risks of mortality (3.24% vs 2.18%, p=0.03), major adverse cardiovascular events (MACE) (3.48% vs 2.47%, p=0.04), pulmonary complications (3.24% vs 2.02%, p=0.01), and 30-day readmission (15.41% vs 13.23%, p=0.03). All other 30-day outcomes were comparable between the groups.
Conclusion: Chronic obstructive pulmonary disease independently increases the risk of 30-day mortality and cardiopulmonary complications after infrainguinal endovascular revascularization. Identification and optimization of COPD patients before considering invasive treatment can be important for preventing complications. Patients may undergo mini-spirometry to screen for COPD. If identified, COPD patients may begin intensive inhalation therapy and medical treatment prior to the surgery.
Clinical impact: Both PAD and COPD are systemic inflammatory diseases that may share similar pathophysiological pathways. This study analyzed the 30-day postoperative outcomes for COPD patients after infrainguinal endovascular revascularization. It was found that COPD independently increases the risk of mortality, cardiopulmonary complications, and 30-day readmissions. Identification and optimization of COPD patients before considering invasive treatment can be important for preventing complications in infrainguinal endovascular revascularization. Patients may undergo mini-spirometry to screen for COPD. If identified, COPD patients may begin intensive inhalation therapy and medical treatment prior to the surgery.
背景:外周动脉疾病(PAD)和慢性阻塞性肺疾病(COPD)都是具有相似病理生理途径的全身性炎症性疾病。考虑到两者的潜在重叠,COPD对腹股沟下血管内重建术围手术期结果的影响值得进一步研究。因此,本研究旨在分析腹股沟下血管内重建术后COPD患者术后30天的预后。方法:从ACS-NSQIP数据库中检索2012 - 2022年行腹股沟下血管内重建术的慢性阻塞性肺疾病和非copd患者。排除标准包括18岁以下和急诊病例。采用1:1的倾向评分匹配来匹配人口统计学、基线特征、症状学和麻醉。比较术后30天的结果。结果:24223例接受腹股沟下血管内重建术的患者中,2472例(10.21%)患有COPD。所有COPD患者与非COPD患者的倾向评分均为1:1匹配。慢性阻塞性肺疾病患者死亡率(3.24% vs 2.18%, p=0.03)、主要心血管不良事件(MACE) (3.48% vs 2.47%, p=0.04)、肺部并发症(3.24% vs 2.02%, p=0.01)和30天再入院(15.41% vs 13.23%, p=0.03)的风险较高。所有其他30天的结果在两组之间具有可比性。结论:慢性阻塞性肺疾病独立增加腹股沟下血管内重建术后30天死亡率和心肺并发症的风险。在考虑侵入性治疗之前对COPD患者进行识别和优化对于预防并发症很重要。患者可接受小型肺活量测定来筛查COPD。如果确诊,COPD患者可在手术前开始强化吸入治疗和药物治疗。临床影响:PAD和COPD都是全身性炎症性疾病,可能具有相似的病理生理途径。本研究分析了腹股沟下血管内重建术后30天COPD患者的术后结果。研究发现,COPD单独增加了死亡率、心肺并发症和30天再入院的风险。在考虑有创治疗前对COPD患者进行识别和优化,对于预防腹股沟下血管内重建术并发症具有重要意义。患者可接受小型肺活量测定来筛查COPD。如果确诊,COPD患者可在手术前开始强化吸入治疗和药物治疗。
期刊介绍:
The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.