Clinical significance of chronic obstructive pulmonary disease in patients undergoing elective total arch replacement

Analysis based on the Japan adult cardiovascular surgery database

on behalf of the Japan Cardiovascular Surgery Database Organization

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE: 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 (FEV1) to forced vital capacity (FVC) of 76% or greater (TAR, n = 10 040); mild COPD, with FEV1/FVC ratio 60-75% and/or use of bronchodilator (TAR, n = 1890); moderate COPD, FEV1/FVC ratio 50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD, FEV1/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.

Original languageEnglish
Article numberezw371
Pages (from-to)761-766
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume51
Issue number4
DOIs
Publication statusPublished - 2017 Apr 1
Externally publishedYes

Fingerprint

Chronic Obstructive Pulmonary Disease
Japan
Databases
Thoracic Aorta
Vital Capacity
Hospital Mortality
Bronchodilator Agents
Forced Expiratory Volume
Respiratory Insufficiency
Ventilation
Pneumonia

Keywords

  • Chronic obstructive pulmonary disease
  • National database
  • Preoperative assessment
  • Total arch replacement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical significance of chronic obstructive pulmonary disease in patients undergoing elective total arch replacement : Analysis based on the Japan adult cardiovascular surgery database. / on behalf of the Japan Cardiovascular Surgery Database Organization.

In: European Journal of Cardio-thoracic Surgery, Vol. 51, No. 4, ezw371, 01.04.2017, p. 761-766.

Research output: Contribution to journalArticle

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title = "Clinical significance of chronic obstructive pulmonary disease in patients undergoing elective total arch replacement: Analysis based on the Japan adult cardiovascular surgery database",
abstract = "OBJECTIVE: 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 (FEV1) to forced vital capacity (FVC) of 76{\%} or greater (TAR, n = 10 040); mild COPD, with FEV1/FVC ratio 60-75{\%} and/or use of bronchodilator (TAR, n = 1890); moderate COPD, FEV1/FVC ratio 50 to 59{\%} and/or use of steroids (TAR, n = 504); and severe COPD, FEV1/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.",
keywords = "Chronic obstructive pulmonary disease, National database, Preoperative assessment, Total arch replacement",
author = "{on behalf of the Japan Cardiovascular Surgery Database Organization} and Shunsuke Miyahara and Hiroaki Miyata and Noboru Motomura and Shinichi Takamoto and Yutaka Okita",
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T2 - Analysis based on the Japan adult cardiovascular surgery database

AU - on behalf of the Japan Cardiovascular Surgery Database Organization

AU - Miyahara, Shunsuke

AU - Miyata, Hiroaki

AU - Motomura, Noboru

AU - Takamoto, Shinichi

AU - Okita, Yutaka

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N2 - OBJECTIVE: 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 (FEV1) to forced vital capacity (FVC) of 76% or greater (TAR, n = 10 040); mild COPD, with FEV1/FVC ratio 60-75% and/or use of bronchodilator (TAR, n = 1890); moderate COPD, FEV1/FVC ratio 50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD, FEV1/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.

AB - OBJECTIVE: 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 (FEV1) to forced vital capacity (FVC) of 76% or greater (TAR, n = 10 040); mild COPD, with FEV1/FVC ratio 60-75% and/or use of bronchodilator (TAR, n = 1890); moderate COPD, FEV1/FVC ratio 50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD, FEV1/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.

KW - Chronic obstructive pulmonary disease

KW - National database

KW - Preoperative assessment

KW - Total arch replacement

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