Original Research: COPD |

Impact of COPD on Postoperative OutcomesCOPD and Postoperative Outcomes: Results From a National Database

Himani Gupta, MD; Bala Ramanan, MBBS; Prateek K. Gupta, MD; Xiang Fang, PhD; Ann Polich, MD; Ariel Modrykamien, MD, FCCP; Dan Schuller, MD, FCCP; Lee E. Morrow, MD, FCCP
Author and Funding Information

From the Department of Medicine (Dr H. Gupta), William S. Middleton Memorial Veterans Hospital, Madison, WI; Department of Surgery (Dr Ramanan), Biostatistical Core (Dr Fang), Department of Medicine (Dr Polich), and Division of Pulmonary, Critical Care and Sleep Medicine (Drs Modrykamien, Schuller, and Morrow), Creighton University, Omaha, NE; and the Department of Surgery (Dr P. Gupta), University of Wisconsin Hospital and Clinics, Madison, WI.

Correspondence to: Prateek K. Gupta, MD, Department of Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792; e-mail: pgupta@uwhealth.org

Part of this article was presented at the CHEST Annual Meeting, October 26-31, 2010, Vancouver, BC, Canada.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;143(6):1599-1606. doi:10.1378/chest.12-1499
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Background:  Although COPD affects large sections of the population, its effects on postoperative outcomes have not been rigorously studied. The objectives of this study were to describe the prevalence of COPD in patients undergoing surgery and to analyze the associations between COPD and postoperative morbidity, mortality, and hospital length of stay.

Methods:  Patients with COPD who underwent surgery were identified from the National Surgical Quality Improvement Program database (2007-2008). Univariate and multivariate analyses were performed on this multicenter, prospective data set (N = 468,795).

Results:  COPD was present in 22,576 patients (4.82%). These patients were more likely to be older, men, white, smokers, and taking corticosteroids and had a lower BMI (P < .0001 for each). Median length of stay was 4 days for patients with COPD vs 1 day in those without COPD (P < .0001). Thirty-day morbidity rates were 25.8% and 10.2% for patients with and without COPD, respectively (P < .0001). Thirty-day death rates were 6.7% and 1.4% for patients with and without COPD, respectively (P < .0001). After controlling for > 50 comorbidities through logistic regression modeling, COPD was independently associated with higher postoperative morbidity (OR, 1.35; 95% CI, 1.30-1.40; P < .0001) and mortality (OR, 1.29; 95% CI, 1.19-1.39; P < .0001). Multivariate analyses with each individual postoperative complication as the outcome of interest showed that COPD was associated with increased risk for postoperative pneumonia, respiratory failure, myocardial infarction, cardiac arrest, sepsis, return to the operating room, and renal insufficiency or failure (P < .05 for each).

Conclusions:  COPD is common among patients undergoing surgery and is associated with increased morbidity, mortality, and length of stay.

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