Postoperative pulmonary complications (PPCs) such as bronchospasm, atelectasis, tracheopulmonary infection, and respiratory failure are thought to occur more frequently in patients with asthma and COPD. Prophylactic inhaled beta-agonist is often administered to reduce perioperative risk in this group despite conflicting evidence. We conducted a retrospective review of patients with previously diagnosed asthma or airway-predominant COPD undergoing non-cardiothoracic surgery to determine the effect of preoperative albuterol on the frequency of PPCs.
Following IRB approval, we identified patients with previously diagnosed asthma or airway-predominant COPD who underwent non-cardiac surgery between January 2003 and December 2008 and determined if albuterol was administered preoperatively. Patients with mild intermittent asthma; those undergoing cardiothoracic surgery; female patients; patients with emphysema-predominant COPD; patients undergoing procedures without general anesthesia and patients being mechanically ventilated prior to surgery were excluded from the study. Univariate analysis was performed by treatment group to compare frequency of PPCs. We used multivariable analysis to evaluate the association between treatment group and PPC, after adjustment for age, duration or surgery, incision site, smoking status, preoperative corticosteroid therapy, type of anesthesia, and serum albumin level. Statistical significance was set at p < 0.05.
One hundred and forty-eight patients were identified as having chronic airways disease, and of these, 43 were treated with albuterol preoperatively. Albuterol pretreatment was not associated with a decrease in the incidence of PPCs overall, or in the incidence of bronchospasm, atelectasis, pneumonia or respiratory failure. 46.5% of patients treated with albuterol experienced PPC, compared to 29.5% of non-treated patients (OR=2.08; 95% CI, 1.0–4.3; p = .05). The overall incidence of PPCs in patients with chronic airways disease was 34.5%.
The frequency of PPCs was significantly higher in patients with chronic airway disease who were treated with albuterol. This may reflect increased disease severity among this subgroup, the presence of an ongoing inflammatory process, or may be an effect of the albuterol itself.
The routine administration of albuterol in patients with chronic airways disease should be further examined.
Isaac Lynch, No Financial Disclosure Information; No Product/Research Disclosure Information