Chest
Volume 143, Issue 6, June 2013, Pages 1599-1606
Journal home page for Chest

Original Research
COPD
Impact of COPD on Postoperative Outcomes: Results From a National Database

https://doi.org/10.1378/chest.12-1499Get rights and content

Abstract

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.

Section snippets

Data Set

Data were extracted from the 2007 and 2008 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Participant Use Data Files.6 These are multicenter, prospective databases of 183 (year 2007) and 211 (year 2008) participating academic and private US hospitals. In 2007, NSQIP collected data on 136 variables (135 in 2008) for patients who underwent major surgical procedures in both the inpatient and the outpatient setting. In NSQIP, a participating hospital's surgical

Demographics

Of the 468,795 patients who underwent surgery, 57.3% were women, and the mean age was 55.0 ± 17.0 years. The overall mean BMI was 30.8 ± 11.2 kg/m2 (interquartile range [IQR], 25.0-34.6 kg/m2); patients with COPD had a significantly lower BMI (P < .0001) and tended to be older than patients without COPD (P < .0001) (Table 2).

Preoperative Comorbidities and Therapy Characteristics

Cardiovascular, renal, neurologic, infectious, liver, and respiratory comorbidities were more commonly seen in patients with COPD than in those without COPD (P < .0001) (

Discussion

The prevalence of COPD is higher among surgical candidates than among age-matched population groups.5 There is, however, a paucity of high-quality studies addressing the association of complications in patients with COPD undergoing surgery. Some studies have shown adverse postoperative outcomes in patients with COPD,14., 15., 16. but these studies have been limited to certain surgical subspecialties with a small number of patients.

In the present study, we included patients from all specialties

Acknowledgments

Author contributions: Dr P. Gupta had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr H. Gupta: contributed to all aspects of the manuscript.

Dr Ramanan: contributed to all aspects of the manuscript.

Dr P. Gupta: contributed to all aspects of the manuscript.

Dr Fang: contributed to all aspects of the manuscript.

Dr Polich: contributed to all aspects of the manuscript.

Dr Modrykamien: contributed to all

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    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.

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