- Title
- Long-term survival after cardiac surgury in patients with chronic obstructive pulmonary disease
- Creator
- Efird, Jimmy T.; Griffin, William; Alger, Lada; Crane, Patricia B.; O'Neal, Wesley T.; Davies, Stephen W.; Shiue, Kristin Y.; Grzybowski, Marysia; Kindell, Linda C.; Kypson, Alan P.; Bowling, Mark; Ferguson, T. Bruce
- Relation
- American Journal of Critical Care Vol. 25, Issue 3, p. 266-276
- Publisher Link
- http://dx.doi.org/10.4037/ajcc2016119
- Publisher
- American Association of Critical Care Nurses
- Resource Type
- journal article
- Date
- 2016
- Description
- Background: Although many patients with chronic obstructive pulmonary disease (COPD) require a prolonged length of stay (PLOS) following coronary artery bypass grafting (CABG), the impact of PLOS on long-term survival has not been examined in this population. Objectives: To determine the association between PLOS and long-term survival among COPD and non-COPD patients after CABG and to examine consequent policy and practice-based implications. Methods: A retrospective cohort study of CABG patients was conducted between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by PLOS. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 203 patients (4.2%) had PLOS after nonemergent CABG (N = 4801). PLOS was an important independent predictor of decreased long-term survival (no COPD, no PLOS: HR = 1.0; COPD, no PLOS: adjusted HR [95% CI], 1.8 [1.5–2.1]; no COPD, PLOS: 3.3 [2.5–4.4]; COPD, PLOS: 6.0 [4.4–8.2]; P Trend < .001). Conclusions: COPD and PLOS are 2 of many factors that affect long-term mortality in postoperative CABG patients. Aggressive treatment strategies aimed at early weaning off of mechanical ventilation and prevention of reintubation among COPD patients must be considered carefully as a means to reduce length of stay after CABG. Our results also have important implications for the long-term management of these patients and strategies for containing costs over the life course of the patient.
- Subject
- cardiac surgury; patients; chronic obstructive pulmonary disease
- Identifier
- http://hdl.handle.net/1959.13/1348241
- Identifier
- uon:30177
- Identifier
- ISSN:1062-3264
- Language
- eng
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