Mild-to-Moderate COPD as a Risk Factor for Increased 30-Day Mortality in Cardiac Surgery

Background: Chronic obstructive pulmonary disease (COPD) is still a serious comorbidity in surgical procedures. We assessed the impact of mild to moderate COPD in a modern cardiac surgery unit. Methods: An age-, gender- and operation-matched cohort analysis of 242 patients treated between 01/2006 and 12/2008 was performed. COPD was defined as a FEV1 < 80% and a FEV1/FVC ratio < 0.7 in preoperative spirometry. Primary end point was 30-day mortality. Results: Preoperative beta-agonist treatment of COPD patients was noted for 43% of patients and not in the control group. After comparable surgery, postoperative respiratory failure was more frequent in COPD patients (10.4% vs. 2.5%, p = 0.02), whereas median ventilation time (12 h) and rate of reintubation (2.5% vs. 3.5%) did not significantly differ between both groups. Intensive care and hospital stay were significantly longer in the COPD group (p= 0.02 and p = 0.04), and 30-day mortality was significantly higher in COPD patients (0.8% vs. 6.1%, p = 0.03). Conclusions: COPD increases 30-day mortality, postoperative pulmonary complications, ICU stay and hospital stay. Proper identification and therapy may help to improve outcome in this high-risk population.