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Operative Risk in Patients With Severe Obstructive Pulmonary Disease
LTC Kurt Kroenke, MC;
Valerie A. Lawrence, MD;
MAJ John F. Theroux, MC;
Michael R. Tuley, PhD
Arch Intern Med. 1992;152(5):967-971.
Abstract
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Background.—
We wanted to determine the risk of post-operative 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.
(Arch Intern Med. 1992;152:967-971)
Author Affiliations
USA; USA
From the Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md, and Walter Reed Army Medical Center, Washington, DC (Dr Kroenke); Division of General Internal Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio (Dr Lawrence); Audie L. Murphy Memorial Veterans Hospital, San Antonio (Drs Lawrence and Tuley); and Brooke Army Medical Center, Fort Sam Houston, Tex (Drs Kroenke and Theroux).
Footnotes
Accepted for publication October 29, 1991.
The opinions or assertions herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.
Reprints not available.
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