Is chronic obstructive pulmonary disease a risk factor for epistaxis after coronary artery bypass graft surgery?
BACKGROUND
Chronic obstructive pulmonary disease (COPD) has customarily been associated with increased surgical morbidity and mortality rates after coronary artery bypass graft surgery (CABG). The aim of this study was to determine whether there is a relationship between epistaxis and COPD after CABG surgery.


METHODS
There were 3 443 patients who consecutively underwent isolated CABG from January 2002 to March 2012. We retrospectively analysed the data of 27 patients (0.8%) with newly developed and serious spontaneous epistaxis, which required consultation with the Ear Nose and Throat (ENT) Department. The patients were divided into three groups according to severity of nasal bleeding. Twenty-one (77.7%) patients in the three groups had COPD.


RESULTS
There were 19 males (70%) and eight females (30%). Their ages ranged between 52 and 72 years (mean 61 ± 5). Fifty-five per cent of the patients had hypertension and 78% had COPD. The overall duration of hospital stay was six to 11 days (mean 7.9 ± 1.1). Epistaxis was seen particularly on the fourth and seventh days postoperatively and 17 patients (63%) were treated with anterior, posterior, or anterior and posterior nasal packing (group 1). Nasal bleeding was controlled with electrocautery in six patients (22%) (group 2), and four (15%) were treated with surgical excision and blood transfusions (group 3). All patients (100%) had a good recovery with no mortality.


CONCLUSIONS
The high coincidence between epistaxis and COPD made us wonder whether COPD may be a risk factor for epistaxis after CABG surgery. However, we could not find any direct causative link between COPD and epistaxis in patients who had undergone CABG. Epistaxis was more common in patients with COPD and it was more serious clinically in patients who had both COPD and hypertension.
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey. fcingoz@yahoo.com.
Faruk
F
Cingoz
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Bilgehan Savas
BS
Oz
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Gokhan
G
Arslan
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Adem
A
Guler
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Mehmet Ali
MA
Sahin
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Celalettin
C
Gunay
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Mehmet
M
Arslan
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D004844:Epistaxis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014421:Turkey / Q000453:epidemiology