Chest
Preoperative Prediction of Postoperative Respiratory Outcome: Coronary Artery Bypass Grafting
Section snippets
Subjects
Six hundred nineteen consecutive adult patients undergoing CABG surgery at the University of Vermont from April 1991 to March 1992 were considered for entry into the study. Inclusion criteria included the angiographic presence of bypassable coronary disease, and referral for anesthesia evaluation. All patients received clinical evaluation, cardiac evaluation, PFTs, including spirometry and arterial blood gas (ABG), and they were operated on. Excluded were those patients for whom PFTs could not
Cohort Characteristics
The cohort represents a typical group of CABG candidates at a referral center. Individual characteristics are described in Table 1. There were approximately equal numbers of routine and urgent procedures (n=219 vs 207, respectively). Approximately 71% of patients were male; most were 50 to 79 years old. Most were smokers at one time, but none admitted to current smoking at the time of preoperative anesthesia evaluation. Clinical congestive heart failure (CHF) was present in 19%, unstable angina
DISCUSSION
The ability to assess risk related to an intervention is central to any risk-benefit analysis in medicine. CABG surgery is both extraordinarily common and resource intensive. We have evaluated the risk for prolonged mechanical ventilation and ICU stay in a series of patients undergoing CABG surgery. Prospectively collected data on preoperative and perioperative variables suspected a priori to be risk factors for adverse respiratory outcome were examined. This was an observational study. No
APPENDIX 1
Parameters Abnormal Range Pulmonary function FVC <75% predicted FEV1 <75% predicted FEV1/FVC ratio <75% PaCO2 in blood >45 mm Hg PaO2 in blood <75 mm Hg PaO2/FIo2 ratio <350 mm Hg Cardiac function LVEF <50% Outcome VENTHRS >48 h SICU days >4 d
APPENDIX 2
COMFAC Index of the presence of any of four comorbid, clinically defined factors, including clinical CHF, angina, diabetes, and smoking history. Scale 0 to 1 (0.25 points per comorbid factor present). Angina Current, stable, or unstable. Age Age cutoffs vary depending on the subgroups examined.
APPENDIX 3
Anthropometrics/demographics: age, sex, height, weight, surface area Smoking history: current, ever, never, pack-years, quit time (patient history) Pneumonia history: ever, recent (patient history) Bronchodilator use: current, frequency (patient history) ABG: pH, PaCO2, PaO2, FI02, measured HCO3 Spirometry: FEV1, % predicted FEV1, FVC, % predicted FVC, FEV1/FVC, FEF25–75, % predicted FEF25–75. Cardiac: CHF, LVEF (radionuclide ventriculogram orPreoperative data
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