The usefulness of preoperative exercise therapy in patients scheduled for lung cancer surgery;: a survey among Dutch pulmonologists and cardiothoracic surgeons

Background Preoperative exercise training (PET) studies show promising results in various patient populations. However, the lack of standardised programmes and uniformity in practice guidelines are barriers for implementation. Aim of this study was to assess the current opinions of pulmonologists and cardiothoracic surgeons on the clinical applicability of PET in patients scheduled for lung cancer surgery. Methods Dutch pulmonologists and cardiothoracic surgeons were asked to complete a 29-question survey regarding PET as an additional option to further optimise the health status of patients scheduled for lung cancer surgery. Results In total, 47 respondents (63% response rate), including 30 pulmonologists and 11 cardiothoracic surgeons and 6 residents in training completed the survey. A vast majority of the respondents had a positive attitude towards PET. Home-based exercise was considered less useful, as well as unsupervised exercise. Patient's motivation, improvements in physical capacity and quality of life, and lifestyle adjustments are important factors for the success of PET. The programme should at least contain inspiratory muscle training (95.7%), lifestyle interventions (95.7%), and supervised exercise training (91.5%). Cardiac and pulmonary risk assessment and medication assessment and optimisation were found less important. Conclusion Among pulmonologists and cardiothoracic surgeons, there is a tendency that PET can be a valuable addition to the perioperative care of lung surgery patients. Points of discussion are the contents of PET programmes, and there seems to be a lack of awareness among chest physicians

The usefulness of preoperative exercise therapy in patients scheduled for lung cancer surgery;:a survey among Dutch pulmonologists and cardiothoracic surgeons

Background Preoperative exercise training (PET) studies show promising results in various patient populations. However, the lack of standardised programmes and uniformity in practice guidelines are barriers for implementation. Aim of this study was to assess the current opinions of pulmonologists and cardiothoracic surgeons on the clinical applicability of PET in patients scheduled for lung cancer surgery. Methods Dutch pulmonologists and cardiothoracic surgeons were asked to complete a 29-question survey regarding PET as an additional option to further optimise the health status of patients scheduled for lung cancer surgery. Results In total, 47 respondents (63% response rate), including 30 pulmonologists and 11 cardiothoracic surgeons and 6 residents in training completed the survey. A vast majority of the respondents had a positive attitude towards PET. Home-based exercise was considered less useful, as well as unsupervised exercise. Patient's motivation, improvements in physical capacity and quality of life, and lifestyle adjustments are important factors for the success of PET. The programme should at least contain inspiratory muscle training (95.7%), lifestyle interventions (95.7%), and supervised exercise training (91.5%). Cardiac and pulmonary risk assessment and medication assessment and optimisation were found less important. Conclusion Among pulmonologists and cardiothoracic surgeons, there is a tendency that PET can be a valuable addition to the perioperative care of lung surgery patients. Points of discussion are the contents of PET programmes, and there seems to be a lack of awareness among chest physicians

Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

Background: Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting. Methods: Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation. Results and Discussion: One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of 50%, long-term survival exceeded expected survival. Conclusions: The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%

Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

Abstract Background Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting. Methods Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation. Results and Discussion One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of 50%, long-term survival exceeded expected survival. Conclusions The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%.</p

Effect of duration of red blood cell storage on early and late mortality after coronary artery bypass grafting

Objectives: Recently, concern has been expressed about the transfusion of older red blood cells after cardiac surgery. We tested the hypothesis that longer storage of transfused red blood cells increases the risk of early and late mortality in patients who undergo coronary artery bypass grafting. Methods: We retrospectively analyzed data of patients who underwent isolated coronary artery bypass grafting between January 1998 and December 2007 in Catharina Hospital, Eindhoven, The Netherlands, and received up to 10 U of red blood cells intraoperatively or during the first 5 postoperative days. The patients were divided into 3 groups according to the storage time of the red blood cells, with a cutoff point of 14 days, as follows: "only younger blood'' (n = 1422), "only older blood'' (n = 1719), and at least 1 U of older RBCs ("any older blood''; n = 2175). Results: The mean follow-up time was 1693 +/- 1058 days (range, 0-3708 days). The median follow-up time was 1629 days. Univariate and multivariate logistic regression analyses revealed that the number of transfused units but not the storage time of blood entered either as a continuous variable or as a dichotomous variable with a cutoff point of 14 days was a risk factor for early mortality. Neither the number of transfused units nor the storage time was an independent risk factor for late mortality. Log-rank testing revealed no statistical difference in survival among the groups. Conclusions: The storage time of transfused red blood cells is not a risk factor for early or late mortality in patients who undergo coronary artery bypass grafting

Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

BACKGROUND: Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting. METHODS: Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation. RESULTS AND DISCUSSION: One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of < 50%. In subjects with a preoperative ejection fraction of > 50%, long-term survival exceeded expected survival. CONCLUSIONS: The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%

Risk Factors for Red Blood Cell Transfusion After Coronary Artery Bypass Graft Surgery

Objectives: Perioperative transfusion of red blood cells is associated with increased morbidity and mortality. The authors investigated the correlation between preoperative risk factors and the number of red blood cell units received in patients undergoing coronary artery bypass graft surgery. Design: A retrospective analysis of prospectively collected data. Setting: A single-center study performed in an educational hospital. Participants: All patients who underwent isolated coronary artery bypass graft surgery between 1998 and 2007 (N = 10,626) were included. Interventions: Isolated coronary artery bypass graft surgery. Measurements and Main Results: Univariate and multivariate logistic regression analyses were performed to investigate the impact of preoperative and perioperative factors on transfusion of 1 or more units of red blood cells. The following independent risk factors for receiving red blood cell units were identified: age, female sex, low body surface area, low left ventricular ejection fraction

Diabetes and survival after coronary artery bypass grafting: comparison with an age- and sex-matched population

Objective: Long-term outcome after coronary artery bypass grafting is worse in diabetic than in non-diabetic patients. No data are currently available regarding survival rates of diabetic and non-diabetic patients after coronary revascularisation compared with cohorts from the general population in the Netherlands, which were matched for age and sex (normal Dutch survival). Methods: We retrospectively analysed the data from 10 626 patients who underwent coronary artery bypass grafting between January 1998 and December 2007. Of these, 8287 patients were non-diabetic, 1587 were non-insulin-dependent and 630 were insulin-dependent diabetic patients (122 patients were lost to follow-up). Survival of these patient groups was compared with the normal Dutch survival. Results: Multivariate analyses revealed non-insulin-dependent diabetes to be a risk factor for early mortality and both insulin-dependent and non-insulin-dependent diabetes as risk factors for late mortality. The 1-, 5- and 10-year survival rates for non-diabetic patients were 94.1% ± 0.3%, 86.8% ± 0.4% and 75.1% ± 1.7%, respectively, which was better than the normal Dutch survival. For insulin-dependent diabetic patients, 1-, 5- and 10-year survival rates were 90.3% ± 1.2%, 78.0% ± 2.0% and 60.5% ± 4.6%, respectively, and for non-insulin-dependent diabetic patients 91.4% ± 0.7%, 79.0% ± 1.3% and 58.9% ± 3.4%, respectively, which was worse than the normal Dutch survival. Conclusions: Non-insulin-dependent diabetes was a risk factor for early mortality and both types of diabetes were risk factors for late mortality after revascularisation. Compared with age- and sex-matched cohorts from the general Dutch population, the 10-year survival of non-diabetic patients was better; whereas the survival of both types of diabetic patients was worse