Adults with COPD Face Higher Risk of Death 1 Year after Surgery, New Study Finds

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Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of death and incur higher high health care costs when undergoing surgery than similar patients without COPD, according to new research.

Findings from a new study published in the Canadian Medical Association Journal showed that COPD was associated with a 61% increase in risk of death and 13% greater total costs in the year after surgery after adjusting for sociodemographic factors and procedure type.

COPD is common among surgical patients, and persons with COPD are at a higher risk for complications and death within 30 days after surgery, according to researchers from the University of Toronto in Ontario.

“Understanding the longer-term outcomes of surgical patients with COPD is critically important to accurately guide informed consent discussions and project care needs. The costs to health systems to care for patients with COPD after surgery are also unknown; delineating these costs would facilitate system-level budgeting and resource allocation,” wrote study authors.

The research team conducted a retrospective population-based cohort study that included 932 616 patients aged ≥35 years in Ontario who underwent surgery between March 2005 to March 2019, including total hip or knee replacement, gastrointestinal surgery, vascular surgery, and other intermediate-to-high-risk elective noncardiac surgeries.

Investigators quantified the association of COPD with survival and health care costs with partial adjustment (for sociodemographic factors and procedure type) and full adjustment (also adjusting for comorbidities). They assessed for effect modification by frailty, cancer, and procedure type.

Among the total study population, 170 482 (18.3%) had physician—diagnosed COPD. Participants with COPD were older and were more frequently men, of lower income quintile, residents of long-term care, and admitted to the hospital before surgery than those without COPD. Also, adults with COPD were more likely to have other pre-existing conditions such as coronary artery disease, congestive heart failure, and lung cancer than those without COPD.

According to the study results, within 30 days after surgery, individuals with COPD had an increased risk of all-cause death, with an unadjusted hazard ratio (HR) of 2.45 (95% CI 2.41-2.50), a partially adjusted HR of 1.61 (95% CI 1.58-1.64), and a fully adjusted HR of 1.26 (95% CI 1.24-1.29).

Regarding the impact on health care costs, patients with COPD had 13.1% ((95% CI 12.7–13.4) higher total costs with partial adjustment and 4.6% (95% CI 4.3–5.0) higher total costs with full adjustment.

Frailty, cancer, and type of surgical procedure modified the associations between COPD and outcomes, according to investigators.

Investigators noted that because they defined the cohort by identifying persons who underwent surgery, selection bias is possible as patients with more severe COPD may not have been offered surgery. “Although this is a possibility, no current perioperative evidence precludes elective noncardiothoracic surgery owing to COPD alone. Nonetheless, the generalizability of our results to patients who are not surgical candidates may be limited,” wrote authors.

The study also did not include a measure of COPD severity, and future work is needed to generate a severe COPD definition that predicts increased risk of postoperative complications, added study authors.

“Perioperative patient care should include comprehensive assessment and treatment tailored not only to COPD, but also to management of concomitant conditions and surgical disease,” concluded researchers.

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.CMAJ. 2023;195:E62-E71.