Morbidity associated with systemic corticosteroid preparation for coronary artery bypass grafting in patients with chronic obstructive pulmonary disease: a case control study

Starobin, Daniele; Kramer, Mordechai R; Garty, Moshe; Shitirt, David

doi:10.1186/1749-8090-2-25

Cited by 20 publications

(16 citation statements)

References 19 publications

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“…Despite some evidence that oral corticosteroids improve pulmonary function after cardiac surgery (1207,1208), their use has not been adopted widely in subjects undergoing CABG. Finally, a consistent reduction in postoperative pulmonary complications has not been shown when off-pump (as opposed to on-pump) CABG is performed (1209).…”

Section: Anomalous Coronary Arteries: Recommendationsmentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

662

161

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Section: Anomalous Coronary Arteries: Recommendationsmentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

662

161

View full text Add to dashboard Cite

“…[101112] Nevertheless, one study reported a higher rate of postoperative wound complications in patients who did not receive preoperative systemic corticosteroids. [9] While another study found that corticosteroid therapy for <10 days before surgery had no impact on postoperative surgical wound complications. [16] Although the results of those studies contradict, corticosteroids were shown to decrease collagen formation during wound healing by suppressing tumor growth factor-β and insulin growth factor-I expression.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies suggested that perioperative systemic corticosteroids are possibly beneficial in COPD patients undergoing coronary artery bypass graft (CABG) surgeries and associated with lower PPC or a shorter intensive care unit and hospital stay. [89] However, other studies suggested increased risk of wound complications associated with steroid therapy. [101112] To our knowledge, the use of preoperative corticosteroids has not been well studied in COPD patients undergoing noncardiothoracic surgery.…”

mentioning

confidence: 99%

Association of preoperative systemic corticosteroid therapy with surgical outcomes in chronic obstructive pulmonary disease patients

et al. 2019

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BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients are at an increased risk of postoperative pulmonary complications (PPCs). The purpose of this study is to evaluate the risks and benefits associated with preoperative steroids in COPD patients. METHODS: The National Surgical Quality Improved Program database was used to identify 92 COPD patients who underwent surgery at the American University of Beirut Medical Center between 2009 and 2013. COPD was diagnosed based on postbronchodilator forced expiratory volume in 1 s to forced vital capacity ratio <0.7 and a history of smoking. The exposure of interest was preoperative systemic corticosteroid therapy. The primary outcomes were PPCs and wound complications. Cardiac and urinary complications along with unplanned readmission or reoperation and death were also evaluated. RESULTS: Overall 42.4% of patients received preoperative systemic corticosteroids. Postoperative wound complications were significantly more frequent in COPD patients who received preoperative systemic corticosteroids compared to patients who did not (10.3% vs. none, respectively, P = 0.03). However, PPCs were not significantly different between patients who received preoperative systemic corticosteroids and patients who did not (17.9% vs. 13.2%, respectively, P = 0.53). There were no significant differences in the secondary outcomes. CONCLUSIONS: This study suggests that preoperative administration of systemic corticosteroids in stable COPD patients is associated with an increased risk of postoperative wound complications but may not reduce PPCs.

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“…As preoperative strategy, smoking cessation, bronchodilator and steroid, hydration, antibiotic and chest physiotherapy may help to optimise the underlying conditions. Use of steroid in peri-operative period in patients with COPD is debatable [36][37][38] . Inspiratory muscles training for 2-4 weeks prior to surgery in high-risk operations such as abdominal aortic aneurysm repair, CABG have shown significant reduction in PPC [39,40] .…”

Section: Pre-existing Pulmonary Pathologymentioning

confidence: 99%

Prevention of Postoperative Pulmonary Complications-Multidisciplinary Approach

Upadhyay¹

2015

JAS

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Postoperative pulmonary complications (PPC) substantially increases the risk of morbidity, mortality, length of hospitalisation and has significant financial implications. Risks of postoperative pulmonary complications can be broadly divided into patient related, procedure related, anaesthesia related and postoperative care related. The prevention of PPC requires comprehensive multidisciplinary approach that include preoperative risk stratification and optimizations, intra-operative lung protective strategies, greater utilization of regional analgesia and avoidance of opioid analgesia, balancing intravenous fluid, minimising blood and blood product transfusion, fast tracking protocol for enhanced recovery, vigilance monitoring, physiotherapy and lung expansion manoeuvres including use of non-invasive ventilation in selected patients and other supportive care such as nutritional support, glycemic control, selective gastric drainage, thrombo-prophylaxis and early empirical antibiotic therapy in suspected infection and sepsis.

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Morbidity associated with systemic corticosteroid preparation for coronary artery bypass grafting in patients with chronic obstructive pulmonary disease: a case control study

Abstract: Background: Coronary artery bypass grafting (CABG) is associated with high morbidity in patients with chronic obstructive pulmonary disease (COPD).

Cited by 20 publications

References 19 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Association of preoperative systemic corticosteroid therapy with surgical outcomes in chronic obstructive pulmonary disease patients

Prevention of Postoperative Pulmonary Complications-Multidisciplinary Approach

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