Key result
Moderate to severe COPD was associated with increased in-hospital mortality in patients undergoing elective total arch replacement compared to controls (OR 1.44; 95% CI 1.08-1.91; P=0.012).
Why the study?
Does the severity of COPD increase in-hospital mortality and morbidity in patients undergoing elective total aortic arch replacement?
Cohort (n=12,590)
Yes
Does the severity of COPD increase in-hospital mortality and morbidity in patients undergoing elective total aortic arch replacement?
Increasing severity of COPD is significantly associated with higher in-hospital mortality and respiratory complications following elective total aortic arch replacement.
May inform risk stratification in elective arch replacement; leaves open whether interventions improve outcomes in prospective studies.
Objectives: We investigated the impact of chronic obstructive pulmonary disease (COPD) on in-hospital outcomes of patients undergoing conventional total aortic arch replacement (TAR), based on the Japan Adult Cardiovascular Surgery Database. Methods: A total of 12 590 patients who underwent elective TAR between 2008 and 2013 were retrospectively reviewed. Patients were divided into 4 categories: normal respiratory function (control), with ratio of forced expiratory volume of air in 1 s (FEV 1 ) to forced vital capacity (FVC) of 76% or greater (TAR, n = 10 040); mild COPD, with FEV 1 /FVC ratio 60-75% and/or use of bronchodilator (TAR, n = 1890); moderate COPD, FEV 1 /FVC ratio 50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD, FEV 1 /FVC ratio less than 50% and/or presence of respiratory failure (TAR, n = 156). Results: In-hospital mortality was 5.7% (5.2% in controls, 7.0% in mild COPD, 9.3% in moderate COPD and 9.0% in severe COPD). A significant trend towards the severity of COPD was noted ( P < 0.0001). A higher incidence of postoperative pneumonia (6.0% in control, 11.0% in mild COPD, 12.3% in moderate COPD and 15.4% in severe COPD; P < 0.0001) and a greater need for prolonged ventilation (17.5% in control, 22.0% in mild COPD, 26.6% in moderate COPD and 29.5% in severe COPD; P < 0.0001) were observed in cases of more severe COPD. The odds ratio of moderate/severe COPD for in-hospital mortality was 1.44 with confidence interval of 1.08-1.91 ( P = 0.012). Conclusions: There was a significant increase in in-hospital mortality and morbidity with increasing severity of COPD in patients who underwent TAR.
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Miyahara et al. (2017) conducted a cohort in Elective total aortic arch replacement (n=12,590). Moderate to severe chronic obstructive pulmonary disease vs. Normal respiratory function was evaluated on In-hospital mortality (OR 1.44, 95% CI 1.08-1.91, p=0.012). Moderate to severe COPD was associated with increased in-hospital mortality in patients undergoing elective total arch replacement compared to controls (OR 1.44; 95% CI 1.08-1.91; P=0.012).
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