PURPOSE: Although COPD is a common problem, its effects on postoperative outcomes have not been rigorously studied. Our objectives were to describe the prevalence of COPD in patients undergoing surgery and to assess the associations between COPD and adverse outcomes (postoperative morbidity, mortality, and length of stay).
METHODS: Patients with COPD (GOLD Stages 2-4) who underwent surgery were identified from the 2007 and 2008 NSQIP database. Using this multicenter, prospective dataset containing 468,795 patients, univariate analyses, multivariate ANOVA and logistic regression analyses were performed.
RESULTS: COPD was present in 22,576 (4.82%) patients. These patients were more likely to be older, males, Caucasians, smokers, alcoholics, on corticosteroids, and had a lower BMI (p<0.0001 for each). They were more likely to have dependent functional status, congestive heart failure, hypertension, diabetes, recent MI/angina, prior cardiac stent/surgery, peripheral vascular disease, dialysis dependence, stroke, bleeding disorder, higher ASA class, and an emergency surgery (p<0.0001 for each). Length of stay was 7.4±11.8 days for COPD patients vs. 3.5±7.2 days in those without COPD (p<0.0001). Thirty-day death rate was 6.7% for COPD patients vs. 1.4% in those without COPD (p<0.0001). After controlling for more than 50 comorbidities, COPD was associated with higher postoperative morbidity (OR 1.35; 95%CI- 1.30-1.40; p<0.0001) and mortality (OR 1.29; 95%CI- 1.19-1.39; p<0.0001) using logistic regression modeling. Multivariate analyses using each individual postoperative complication as the outcome of interest showed that COPD was associated with increased risk for pneumonia, respiratory failure, myocardial infarction, cardiac arrest, sepsis, return to operating room, and renal insufficiency/failure (p<0.05 for each).
CONCLUSION: GOLD stage 2-4 COPD is common among patients undergoing surgery and is associated with increased morbidity, mortality, and length of stay.
CLINICAL IMPLICATIONS: Knowledge of the increased risk associated with COPD may improve patient selection and the informed consent process. 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.
DISCLOSURE: Himani Gupta, No Financial Disclosure Information; No Product/Research Disclosure Information