INFLUENCE OF AGE-SPECIFIC LUNG-FUNCTION ON SURVIVAL AFTER CORONARY-BYPASS

Background, Respiratory complications after successful coronary artery bypass grafting influence the immediate recovery of a patient; howeve r, whether they influence the longevity of a patient is largely unknow n. The aim of this study was to examine the effects of preoperative pu lmonary risk factors in younger patients and older patients on outcome after coronary artery bypass grafting, Methods. A retrospective chart review was performed on 939 patients who underwent primary coronary a rtery bypass grafting between July 1987 and November 1996. For better comparison, they were arbitrarily divided by age into two groups: grou p 1, less than 70 years old (n = 710), and group 2, 70 years old or ol der (n = 229). The variables collected for each patient included histo ry of chronic obstructive pulmonary disease, active smoking, forced ex piratory volume, and ventilatory support for more than 48 hours. These variables were compared with postoperative length of stay in the inte nsive care unit, length of stay in the hospital, and the midterm survi val up to 5 years. The data were analyzed by the use of univariate/mul tivariate log-rank tests and the method of Kaplan-Meier survival estim ates. Results. The presence of chronic obstructive pulmonary disease w as associated with increased length of stay in the intensive care unit and in the hospital for both groups. Preoperative forced expiratory v olume in 1 second, significantly affected length of stay in the hospit al only in the patients less than 70 years old (p = 0.0001). Delayed e xtubation beyond 48 hours of ventilatory support resulted in prolonged length of stay in the intensive care unit and in the hospital for pat ients less than 70 years old (p = 0.0001, p = 0.0001, respectively) an d patients 70 years old or older (p = 0.0001, p = 0.0001, respectively ). The 5-year survival after coronary artery bypass grafting for both groups was significantly influenced by the level of preoperative force d expiratory volume in I second (p = 0.0004, p = 0.0282, respectively) . Conclusions. Patients with chronic obstructive pulmonary disease, ir respective of age, stay in the intensive care unit and in the hospital longer after coronary artery bypass grafting. In addition, preoperati ve forced expiratory volume in 1 second is a significant predictor of 5-year survival in the young and aged individuals undergoing coronary artery bypass grafting. (Ann Thorac Surg 1998;66:144-7) (C) 1998 by Th e Society of Thoracic Surgeons.