The severity of chronic obstructive pulmonary disease is associated with adverse outcomes after open thoracoabdominal aortic aneurysm repair

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-12-01 DOI:10.1016/j.jtcvs.2023.09.067

Vicente Orozco-Sevilla MD , Christopher T. Ryan MD , Kimberly R. Rebello MD, MSc , Lynna H. Nguyen MS , Ian O. Cook MD , Ginger M. Etheridge BBA , Susan Y. Green MPH , Thomas Bini BS , Subhasis Chatterjee MD , Marc R. Moon MD , Scott A. LeMaire MD , Joseph S. Coselli MD

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引用次数: 0

Abstract

Objective

We assessed associations between outcomes after open thoracoabdominal aortic aneurysm (TAAA) repair and preoperative airflow limitation stratified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric classification of chronic obstructive pulmonary disease (COPD) severity.

Methods

Among 2368 open elective TAAA repairs in patients with spirometric data, 1735 patients had COPD and 633 did not. Those with COPD were stratified by preoperative respiratory dysfunction as GOLD 1 (forced expiratory volume in the first second of expiration [FEV₁] ≥80% of predicted; n = 228), GOLD 2 (50% ≤ FEV₁ < 80% of predicted; n = 1215), GOLD 3 (30% ≤ FEV₁ < 50% of predicted; n = 260), or GOLD 4 (FEV₁ < 30% of predicted; n = 32). Early outcomes included operative mortality and adverse events (operative death or persistent stroke, spinal cord deficit, or renal failure requiring dialysis); associations of outcomes were determined using logistic regression models. Kaplan–Meier analysis compared late survival by the log-rank test.

Results

Pulmonary complications occurred in 38.4% of patients with COPD versus 30.0% without COPD (P < .001). Operative mortality and adverse events were more frequent in patients with COPD than without COPD (7.9% vs 3.8% [P < .001] and 14.9% vs 9.8% [P = .001], respectively). Worsening GOLD severity was independently associated with operative death and adverse event. Survival was poorer in patients with COPD than in those without (61.9% ± 1.2% vs 73.6% ± 1.8% at 5 years; P < .001), particularly in patients with increasing GOLD severity (68.7% ± 3.2% vs 63.7% ± 1.4% vs 51.4% ± 3.2% vs 31.3% ± 8.2% at 5 years; P < .001).

Conclusions

Patients with COPD are at elevated risk for operative death and adverse events. Staging by GOLD severity aids preoperative risk stratification. Patients with airflow limitations may benefit from optimization before TAAA repair.

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慢性阻塞性肺疾病的严重程度与开胸腹主动脉瘤修复后的不良后果有关。

目的：我们评估了开放性胸腹主动脉瘤（TAAA）修复后的结果与术前气流限制之间的关系，该关系根据慢性阻塞性肺病全球倡议（GOLD）对慢性阻塞性肺疾病（COPD）严重程度的肺活量分类进行分层。方法：在2368例有肺活量测量数据的开放性选择性TAAA修复患者中，1735例患有COPD，633例没有。COPD患者按术前呼吸功能障碍分级为GOLD 1（FEV1≥预测值的80%；n=228），GOLD 2（50%≤FEV111）结果：38.4%的COPD患者发生肺部并发症，而30.0%的非COPD患者发生肺并发症（P结论：COPD患者手术死亡和不良事件的风险较高。GOLD严重程度分级有助于术前风险分层。气流受限的患者可能受益于TAAA修复前的优化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.