Patients With COPD at Increased Risk of Death After Major Surgical Procedure

Chronic obstructive pulmonary disease (COPD) is a common disease among patients who undergo surgery, but surgery comes at a higher risk for COPD patients compared with patients without COPD, according to the results of a recent study.

A team of researchers sought to establish the long-term postoperative survival and costs of patients with COPD when compared with patients without COPD. They found that patients with COPD who undergo major surgery have a lower survival rate compared with patients without COPD and may die within a year of surgery.

For their retrospective, population-based cohort study, the researchers included a total of 932,616 patients. Of the total, 18% of patients (n = 170,482) were diagnosed with COPD. Participants underwent inpatient elective surgery (i.e. knee replacement, gastrointestinal surgery, vascular surgery, other elective noncardiac surgeries) and were followed 1-year post-operation to evaluate survival and costs to the health system.

The researchers found that 10.6% of patients with COPD (n = 18,007) and 4.5% of patients without COPD (n = 34,014) died during the year after surgery. Further, patients with COPD were more likely to die within the 30 days after surgery (3.4%) compared with those without COPD (1.2%). Overall, patients with COPD had an increased risk of all-cause mortality.

Additionally, patients with COPD had a 13% increase in health care costs a year following their surgery. The researchers note that frailty, cancer, and type of surgical procedure “modified associations between COPD and outcomes.”

“Patients with COPD typically have concurrent comorbidity, biopsychosocial issues and frailty…” the researchers wrote. “…Disentangling the direct effects of COPD, associated comorbidity or frailty on patients’ outcomes is challenging. Our findings highlight the importance of careful risk prediction and decision-making for patients with COPD who are considering surgery.”

The study had some limitations, including the possibility of selection bias as the researchers identified their cohort by patients who underwent surgery. The selection bias may have excluded patients who had a more severe disease but were not offered surgery. Additionally, the study did not include the severity of COPD in each patient.

Despite the study’s limitations, the researchers’ hope their findings show the potential burden and risk of patients with COPD undergoing major surgical procedures.

“The association between COPD and adverse outcomes persists beyond the immediate perioperative period, and is affected by frailty, cancer, and type of surgery,” the authors conclude. “Perioperative patient care should include comprehensive assessment and treatment tailored not only to COPD but also to management of concomitant conditions and surgical disease.”

 

Reference:

Sankar A, Thorpe K, McIsaac DI, Luo J, Wijeysundera DN, Gershon AS. Survival and health care costs after inpatient elective surgery: comparison of patients with and without chronic obstructive pulmonary disease. Can Med Assoc J. Published online January 17, 2023. doi: 10.1503/cmaj.220733