Postoperative Outcomes Worse in COPD Patients

VANCOUVER, B.C. – Patients with chronic obstructive pulmonary disease are more likely to die after surgery than are those without COPD, even after controlling for comorbidities and type of surgery, according to a cross-sectional study of nearly half a million patients undergoing surgery in the United States.

The researchers found that patients with COPD were 29% more likely to die and 35% were more likely to experience complications, compared with similar patients without the disease, said presenting investigator Dr. Prateek K. Gupta, a surgeon at Creighton University in Omaha, Neb.

In addition, hospital length of stay was four times longer for the COPD group.

"Knowledge of the increased risk associated with COPD may improve patient selection and the informed consent process," Dr. Gupta said at the annual meeting of the American College of Chest Physicians.

"Perioperative optimization of these patients may help in improving outcomes and health care costs, and there is a need to study such strategies in multicenter, randomized, prospective trials," he added. These strategies might include, for example, giving patients respiratory exercises and encouraging them to quit smoking, he said.

Dr. Gupta and his colleagues used the NSQIP (National Surgical Quality Improvement Program) database, which collects data from more than 250 hospitals nationwide, to identify patients who underwent surgery in 2007 and 2008.

They then compared 30-day postoperative outcomes between patients who did and did not have COPD, defined in the database as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II, III, or IV or a prior hospitalization for COPD.

Analyses included 468,795 patients who underwent surgery. The types of surgery were typical of those seen in the general population, according to Dr. Gupta, with a predominance of cholecystectomy, appendectomy, hernia repair, and vascular and breast surgeries.

A total of 5% of the patients had COPD. Relative to their unaffected peers, patients with COPD had a higher mean body mass index (29 vs. 28 kg/m2) and an older median age (69 vs. 55 years); were more likely to be male (52% vs. 42%), white (82% vs. 72%), smokers (41% vs. 20%), and alcoholics (5% vs. 2%); and were more likely to be taking corticosteroids (10% vs. 3%).

The group with COPD also had higher prevalences of more than a dozen comorbidities, especially hypertension (74% vs. 44%), dependent functional status (20% vs. 6%), diabetes (25% vs. 14%), and an American Society of Anesthesiologists score of 3 or 4 (55% vs. 22%).

The median length of hospital stay was much longer for the patients with COPD than for their unaffected peers, at 4 days vs. 1 day (P less than .0001), Dr. Gupta reported. And the 30-day rate of postoperative mortality was higher, at 6.7% vs. 1.4% (P less than .0001).

After the investigators took into account more than 50 comorbidities and the type of surgery (including whether it was laparoscopic or open), patients with COPD still had higher risks of postoperative morbidity (odds ratio, 1.35; P less than .0001) and mortality (OR, 1.29; P less than .0001).

The odds of nine postoperative complications individually were also elevated for the COPD group, with the greatest increases seen for pneumonia (OR, 1.71), reintubation (OR, 1.54), and failure to wean from the ventilator within 48 hours (OR, 1.45) (all P less than .0001).

The study was limited by a lack of detailed information on therapies that patients were receiving, Dr. Gupta acknowledged. "We just know that they had this surgery [and] that they had COPD prior. We don’t know what medication or what preoperative optimization they underwent," he said.

In addition, the study did not specifically assess any influence of the urgency of the surgery (emergency vs. elective) and did not assess the potential impact of mild COPD.

GOLD stage II-IV COPD is "common among patients undergoing surgery and is associated with increased morbidity, mortality, and length of stay," Dr. Gupta concluded. Physicians may be able to use this information to help guide selection of appropriate surgical candidates, counsel patients about risks, and target interventions to improve outcomes, he said.

Dr. Gupta reported having no conflicts of interest related to the research.

VANCOUVER, B.C. – Patients with chronic obstructive pulmonary disease are more likely to die after surgery than are those without COPD, even after controlling for comorbidities and type of surgery, according to a cross-sectional study of nearly half a million patients undergoing surgery in the United States.

The researchers found that patients with COPD were 29% more likely to die and 35% were more likely to experience complications, compared with similar patients without the disease, said presenting investigator Dr. Prateek K. Gupta, a surgeon at Creighton University in Omaha, Neb.

In addition, hospital length of stay was four times longer for the COPD group.

"Knowledge of the increased risk associated with COPD may improve patient selection and the informed consent process," Dr. Gupta said at the annual meeting of the American College of Chest Physicians.

"Perioperative optimization of these patients may help in improving outcomes and health care costs, and there is a need to study such strategies in multicenter, randomized, prospective trials," he added. These strategies might include, for example, giving patients respiratory exercises and encouraging them to quit smoking, he said.

Dr. Gupta and his colleagues used the NSQIP (National Surgical Quality Improvement Program) database, which collects data from more than 250 hospitals nationwide, to identify patients who underwent surgery in 2007 and 2008.

They then compared 30-day postoperative outcomes between patients who did and did not have COPD, defined in the database as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II, III, or IV or a prior hospitalization for COPD.

Analyses included 468,795 patients who underwent surgery. The types of surgery were typical of those seen in the general population, according to Dr. Gupta, with a predominance of cholecystectomy, appendectomy, hernia repair, and vascular and breast surgeries.

A total of 5% of the patients had COPD. Relative to their unaffected peers, patients with COPD had a higher mean body mass index (29 vs. 28 kg/m2) and an older median age (69 vs. 55 years); were more likely to be male (52% vs. 42%), white (82% vs. 72%), smokers (41% vs. 20%), and alcoholics (5% vs. 2%); and were more likely to be taking corticosteroids (10% vs. 3%).

The group with COPD also had higher prevalences of more than a dozen comorbidities, especially hypertension (74% vs. 44%), dependent functional status (20% vs. 6%), diabetes (25% vs. 14%), and an American Society of Anesthesiologists score of 3 or 4 (55% vs. 22%).

The median length of hospital stay was much longer for the patients with COPD than for their unaffected peers, at 4 days vs. 1 day (P less than .0001), Dr. Gupta reported. And the 30-day rate of postoperative mortality was higher, at 6.7% vs. 1.4% (P less than .0001).

After the investigators took into account more than 50 comorbidities and the type of surgery (including whether it was laparoscopic or open), patients with COPD still had higher risks of postoperative morbidity (odds ratio, 1.35; P less than .0001) and mortality (OR, 1.29; P less than .0001).

The odds of nine postoperative complications individually were also elevated for the COPD group, with the greatest increases seen for pneumonia (OR, 1.71), reintubation (OR, 1.54), and failure to wean from the ventilator within 48 hours (OR, 1.45) (all P less than .0001).

The study was limited by a lack of detailed information on therapies that patients were receiving, Dr. Gupta acknowledged. "We just know that they had this surgery [and] that they had COPD prior. We don’t know what medication or what preoperative optimization they underwent," he said.

In addition, the study did not specifically assess any influence of the urgency of the surgery (emergency vs. elective) and did not assess the potential impact of mild COPD.

GOLD stage II-IV COPD is "common among patients undergoing surgery and is associated with increased morbidity, mortality, and length of stay," Dr. Gupta concluded. Physicians may be able to use this information to help guide selection of appropriate surgical candidates, counsel patients about risks, and target interventions to improve outcomes, he said.

Dr. Gupta reported having no conflicts of interest related to the research.

VANCOUVER, B.C. – Patients with chronic obstructive pulmonary disease are more likely to die after surgery than are those without COPD, even after controlling for comorbidities and type of surgery, according to a cross-sectional study of nearly half a million patients undergoing surgery in the United States.

The researchers found that patients with COPD were 29% more likely to die and 35% were more likely to experience complications, compared with similar patients without the disease, said presenting investigator Dr. Prateek K. Gupta, a surgeon at Creighton University in Omaha, Neb.

In addition, hospital length of stay was four times longer for the COPD group.

"Knowledge of the increased risk associated with COPD may improve patient selection and the informed consent process," Dr. Gupta said at the annual meeting of the American College of Chest Physicians.

"Perioperative optimization of these patients may help in improving outcomes and health care costs, and there is a need to study such strategies in multicenter, randomized, prospective trials," he added. These strategies might include, for example, giving patients respiratory exercises and encouraging them to quit smoking, he said.

Dr. Gupta and his colleagues used the NSQIP (National Surgical Quality Improvement Program) database, which collects data from more than 250 hospitals nationwide, to identify patients who underwent surgery in 2007 and 2008.

They then compared 30-day postoperative outcomes between patients who did and did not have COPD, defined in the database as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II, III, or IV or a prior hospitalization for COPD.

Analyses included 468,795 patients who underwent surgery. The types of surgery were typical of those seen in the general population, according to Dr. Gupta, with a predominance of cholecystectomy, appendectomy, hernia repair, and vascular and breast surgeries.

A total of 5% of the patients had COPD. Relative to their unaffected peers, patients with COPD had a higher mean body mass index (29 vs. 28 kg/m2) and an older median age (69 vs. 55 years); were more likely to be male (52% vs. 42%), white (82% vs. 72%), smokers (41% vs. 20%), and alcoholics (5% vs. 2%); and were more likely to be taking corticosteroids (10% vs. 3%).

The group with COPD also had higher prevalences of more than a dozen comorbidities, especially hypertension (74% vs. 44%), dependent functional status (20% vs. 6%), diabetes (25% vs. 14%), and an American Society of Anesthesiologists score of 3 or 4 (55% vs. 22%).

The median length of hospital stay was much longer for the patients with COPD than for their unaffected peers, at 4 days vs. 1 day (P less than .0001), Dr. Gupta reported. And the 30-day rate of postoperative mortality was higher, at 6.7% vs. 1.4% (P less than .0001).

After the investigators took into account more than 50 comorbidities and the type of surgery (including whether it was laparoscopic or open), patients with COPD still had higher risks of postoperative morbidity (odds ratio, 1.35; P less than .0001) and mortality (OR, 1.29; P less than .0001).

The odds of nine postoperative complications individually were also elevated for the COPD group, with the greatest increases seen for pneumonia (OR, 1.71), reintubation (OR, 1.54), and failure to wean from the ventilator within 48 hours (OR, 1.45) (all P less than .0001).

The study was limited by a lack of detailed information on therapies that patients were receiving, Dr. Gupta acknowledged. "We just know that they had this surgery [and] that they had COPD prior. We don’t know what medication or what preoperative optimization they underwent," he said.

In addition, the study did not specifically assess any influence of the urgency of the surgery (emergency vs. elective) and did not assess the potential impact of mild COPD.

GOLD stage II-IV COPD is "common among patients undergoing surgery and is associated with increased morbidity, mortality, and length of stay," Dr. Gupta concluded. Physicians may be able to use this information to help guide selection of appropriate surgical candidates, counsel patients about risks, and target interventions to improve outcomes, he said.

Dr. Gupta reported having no conflicts of interest related to the research.