Postoperative Pulmonary Complications after Coronary Artery Bypass Graft Surgery (CABG)
Keywords:
coronary artery bypass surgery, thoracic complications, pleural effusion, respiratory failure, pneumonia, pneumothoraxAbstract
Background: Coronary artery bypass grafting (CABG) is the most common surgical treatment for ischemic heart disease, first discovered in 1954. It has undergone significant advancements, particularly with the advent of angiographic imaging that allows for direct intervention on the affected vessels. As surgical techniques, anesthesia, and postoperative care have evolved, the characteristics of patients undergoing this surgery have changed to include elderly individuals, women, patients with left heart failure (reduced left ventricular contractility), and those with stable angina. Due to these variations in patient profiles, an increase in the incidence of postoperative complications, especially pulmonary complications, has been observed. Despite considerable progress in surgical techniques and postoperative care, further research is needed to investigate the incidence of these complications, their impact on recovery duration and mortality rates, and their relationship with studied risk factors.
Objective: To study the prevalence of pulmonary complications following CABG and their relationship with preoperative, intraoperative, and postoperative risk factors, as well as to examine the impact of pulmonary complications on recovery duration.
Methods: The study included a sample of 287 patients who underwent CABG at the Bassel Center for Heart Diseases and Surgery and Tishreen University Hospital in Latakia. Patients were monitored throughout their recovery period via clinical history taking, physical examinations, and documentation of medical history and risk factors before, during, and after surgery.
Results: All patients developed one or more of the studied pulmonary complications. The most common complication was pleural effusion 79.5%, followed by pulmonary atelectasis 38.5% and pneumonia 10.1%. The incidence of respiratory failure was 5.7%, while pneumothorax occurred in 5.3%. Independent risk factors for developing these complications included: for pleural effusion—heart failure and bilateral thoracotomy; for pulmonary atelectasis—advanced age, diabetes mellitus, and prolonged surgery duration; for pneumonia—extended duration of surgery, mechanical ventilation, and hospital stay; for pneumothorax—COPD, bronchiectasis, and prolonged ventilation; and for respiratory failure—smoking and previous COPD history.
Conclusion: This study highlights the prevalence of pulmonary complications following coronary artery bypass graft surgery, as well as identifying the risk factors associated with each complication. Understanding these relationships can contribute to improving preoperative assessment and postoperative care strategies, which may help reduce complications and enhance outcomes. Additionally, further research is needed to explore interventions that could decrease the occurrence of complications in high-risk patients.
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