PURPOSE: One of the characteristics of COPD is the tendency to develop acute exacerbation, defined by the presence of different clinical findings as worsening dyspnea, increase in sputum purulence and volume. As the nosologic entity of postoperative exacerbation of COPD does not exist, this study was designed to verify if definition of acute COPD exacerbation is appliable to patients who underwent pulmonary surgery, and if it has any impact on postoperative morbidity and mortality.
METHODS: This study was designed to prospectively enroll 1000 patients undergoing pulmonary resection for lung cancer from different thoracic surgery centers. In absence of concomitant pulmonary complication, severe postoperative exacerbation of COPD was defined as the presence of a deteriorating dyspnea score, purulent sputum, and a bronchial secretion volume >10 ml/24hours; moderate exacerbation was defined as the presence of 2 of these findings; mild exacerbation was defined as the presence of one of these finding and one of the following clinical criteria: fever without other apparent cause, increased wheezing, increased cough.
RESULTS: Postoperative stay in exacerbated patients was significantly longer as compared to uncomplicated patients without exacerbation (6.3±1.3 versus 8.3±1.1, p 0.00). A postoperative exacerbation of COPD was recorded in 276 patients and 152 of them (55%) subsequently developed respiratory complications. Univariate analysis identified sex, preoperative FEV1%, duration of surgery and COPD exacerbation as risk factors for the occurrence of respiratory morbidity. Multivariate analysis confirmed their role (males OR 1.7, CI 1.0-3.1, preop FEV1380% OR 0.43, CI 0.2-0.7, duration>110 min OR 2.2 CI 1.4-3.3).
CONCLUSION: Postoperative exacerbation of COPD is an existing, frequent clinical entity after lung resection and, when present, it increases the risk of pulmonary complications.
CLINICAL IMPLICATIONS: The existing GOLD guidelines for the treatment of acute exacerbation should be adapted for the management of patients after lung resection in order to test the hypothesis that they could reduce respiratory morbidity.
DISCLOSURE: Francesco Leo, No Financial Disclosure Information; No Product/Research Disclosure Information