Patients with COPD have higher mortality in year after surgery

Patients diagnosed with chronic obstructive pulmonary disease (COPD) who have major surgery have a higher mortality rate in the year after surgery than similar patients who do not have COPD, researchers reported on Jan. 17, 2023 in the Canadian Medical Association Journal.

As background to the study, the authors said, “Chronic obstructive pulmonary disease (COPD) is common among surgical patients, and patients with COPD have higher risk for complications and death within 30 days after surgery. We sought to describe the longer­-term postoperative survival and costs of patients with COPD compared with those without COPD within 1 year after inpatient elective surgery.

From national databases, the investigators identified all patients who had undergone inpatient elective surgery in Ontario, Canada, from 2005 to 2019. And they determined their COPD status at the time of surgery.

They tracked the subjects for 1 year from surgery to determine and compare survival and costs.

The study included 932,616 subjects aged 35 years and older who had undergone major surgery, including total hip or knee replacement, gastrointestinal surgery, vascular surgery and other elective noncardiac surgeries.

They found that about 1 in 5 (170,482) of all subjects had COPD.

Subjects with COPD were older, and more likely to be male, frail, have lower income and have pre-existing conditions such as coronary artery disease, diabetes and lung cancers.

The investigators reported that, when compared to similar patients without COPD undergoing similar surgery, the subjects with COPD had a 61% increased risk of death and a 13% increase in health care costs during the year after surgery.

“Patients with COPD typically have concurrent comorbidity, biopsychosocial issues and frailty,” the authors said. “Our findings highlight the importance of careful risk prediction and decision-making for patients with COPD who are considering surgery.”

“Because patients with COPD are often frail and have many health problems, their management around the time of surgery should address not only COPD but all their health issues,” added lead investigator Ashwin Sankar, MD,, Clinician-Investigator in anesthesiology and perioperative medicine based at St. Michael’s Hospital in Toronto, and an Assistant Professor in the Department of Anesthesiology and Pain Medicine at the University of Toronto.