Chronic obstructive pulmonary disease associated with worse postoperative outcomes

1. Patients with chronic obstructive pulmonary disease (COPD) had lower survival rates and greater healthcare costs compared to patients without COPD following inpatient elective surgery

Evidence Rating Level: 2 (Good)

Patients with chronic obstructive pulmonary disease (COPD) continue to have an increased risk of complications and worse outcomes following surgery, which poses significant challenges to our healthcare systems. This association may be multifactorial with baseline respiratory function, age, and the presence of other comorbidities influencing health outcomes. However, the exact impacts of COPD on the healthcare system and the survival of these patients following inpatient elective surgery are not known. As such, this retrospective cohort study aimed to compare survival and healthcare costs one year following inpatient elective surgery between patients with and without COPD. This study included 932,616 adult patients older than 35 years of age living in Ontario who underwent elective non-cardiac surgeries, without prior lung transplants or surgery for lung volume reduction. The diagnosis of COPD was made by physicians and required one or more ambulatory presentations or hospital admissions for COPD prior to their surgery date. The primary outcome of this study was all-cause death within one year following surgery and the secondary outcome was total healthcare costs. The results of this study showed that patients with COPD had an increased risk of all-cause death following surgery compared to those with no history of COPD (adjusted hazard ratio [aHR] 1.26, 95%CI 1.24-1.29). Additionally, compared with patients who did not have COPD, patients with COPD acquired increased healthcare costs during their hospital admissions and the year following their surgery. Ultimately, this study suggests that patients with COPD had lower survival rates and greater healthcare costs. Of note, individuals with COPD typically had concurrent comorbidities, other psychosocial issues, and frailty. There are several limitations that should be noted. For instance, this study did not include a measure of COPD severity when assessing outcomes following surgery. Nevertheless, as COPD is very prominent among patients undergoing inpatient elective surgery, the findings of this paper are very relevant to perioperative medicine.

Click to read the study in CMAJ

Image: PD

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