OPERATIVE RISK IN PATIENTS WITH SEVERE OBSTRUCTIVE PULMONARY-DISEASE

被引:161
作者
KROENKE, K
LAWRENCE, VA
THEROUX, JF
TULEY, MR
机构
[1] WALTER REED ARMY MED CTR,WASHINGTON,DC 20307
[2] UNIV TEXAS,HLTH SCI CTR,DEPT MED,DIV GEN INTERNAL MED,SAN ANTONIO,TX 78284
[3] AUDIE L MURPHY MEM VET ADM MED CTR,SAN ANTONIO,TX 78284
[4] BROOKE ARMY MED CTR,FT SAM HOUSTON,TX 78234
关键词
D O I
10.1001/archinte.152.5.967
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. - We wanted to determine the risk of postoperative pulmonary complications and mortality in patients with severe chronic obstructive pulmonary disease. Methods. - We reviewed 107 consecutive operations performed in 89 patients with severe chronic obstructive pulmonary disease (forced expiratory volume in 1 second, < 50% of predicted). Results. - Postoperative pulmonary complications occurred in 31 operations (29%) and were significantly related to the type and duration of surgery. Also, American Society of Anesthesiologists class approached significance as a predictor. Postoperative pulmonary complications occurred at higher rates in coronary artery bypass grafting and major abdominal procedures (60% and 56%) than in other operations involving general or spinal anesthesia (27%) or in procedures performed with the patient under regional or local anesthesia (16%). When the durations of the operations were classified as less than 1 hour, 1 to 2 hours, 2 to 4 hours, and more than 4 hours, the rates of postoperative pulmonary complications were 4%, 23%, 38%, and 73%, respectively. Regarding American Society of Anesthesiologists class, postoperative pulmonary complications occurred in 10% of patients in class II, 28% of those in class III, and 46% of those in class IV. In terms of life-threatening complications, there were six deaths and only two cases of nonfatal ventilatory failure. Notably, mortality clustered primarily in coronary artery bypass graft procedures. Five of 10 patients receiving coronary artery bypass grafts died, compared with one death after 97 non-coronary artery bypass graft operations (50% vs 1%). Conclusions. - Although the risk of coronary artery bypass grafting deserves further study, noncardiac surgery carries an acceptable operative risk in patients with severe chronic obstructive pulmonary disease.
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页码:967 / 971
页数:5
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