patient chronic obstructive pulmonary disease Data suggest that (COPD) patients are more likely to die within a year of undergoing elective surgery and have higher medical costs than similar patients without COPD.
An analysis of nearly 1 million patient records found that after adjusting for sociodemographic factors, type of procedure, and comorbidities, patients with COPD were more likely to die within 1 year after surgery than patients without COPD26. % found to be high. Additionally, COPD was associated with his 4.6% increase in medical costs.
Dr. Ashwin Sankar
Previous studies have evaluated results in the first 30 days after surgery. These data “may not fully capture the overall burden of surgery and the time it takes for patients to recover,” said study author and clinical investigator at St. Michael’s Hospital. , said Ashwin Sanker, M.D., Ph.D. anesthesia at the University of Toronto, Medscape Medical News.
“We have found that COPD often coexists with other conditions such as diabetes. coronary artery disease“We encourage clinicians to use COPD as a flag for other conditions to ensure that all modifiable risk factors are optimized prior to surgery.”
the study Published Online January 17 Journal of the Canadian Medical Association.
Additional recovery support
The authors analyzed data from 932,616 patients who underwent elective non-cardiac surgery at moderate to high risk between 2005 and 2019 in Ontario, Canada.Included steps carotid endarterectomyopen or intravascular abdominal aortic aneurysm repair, peripheral arterial bypass, total hip replacement, total knee arthroplastyshoulder surgery, colon surgery, partial liver resection, pancreaticoduodenectomy, gastrectomy, esophagectomy, nephrectomy, cystectomy, prostatectomyand hysterectomy.
Researchers have quantified the association between COPD and survival and costs. Their analyzes included partial adjustment for sociodemographic factors and treatment type and full adjustment for comorbidities.
The primary outcome was all-cause mortality 1 year after surgery. A secondary outcome was total medical expenses for the year.
The mean age of the population was 65 years, and 60% of patients were female. A total of 170,482 (18%) patients had her COPD. Compared with patients without COPD, patients with COPD were older, more likely to be male, more likely to be in the lower income quantile, more likely to be residents of long-term care facilities, They were more likely to have been hospitalized before surgery. They were also more likely to have comorbidities, including coronary artery disease. congestive heart failureand lung cancer.
Most of the COPD patients were frail and had moderate to severe comorbidities. They are also more likely to undergo orthopedic surgery, open upper abdominal surgery, and vascular surgery.
One year after surgery, 52,021 (5.6%) patients died, including 18,007 (10.6%) with COPD and 34,014 (4.5%) without COPD. COPD patients were more likely to die within 30 days after surgery (3.4% vs. 1.2%).
For COPD patients, the partially adjusted hazard ratio (HR) for mortality risk was 1.61. The fully adjusted HR was 1.26. COPD was also associated with a partially adjusted relative increase in health care costs of 13.1% and a fully adjusted increase of 4.6%.
Vulnerability, cancer, and type of procedure were factors that modified the association between COPD and outcome. “Procedures such as aortotomy and upper abdominal surgery are associated with increased postoperative risk regardless of COPD status, whereas procedures such as orthopedic surgery and lower abdominal surgery may pose significantly higher risk for COPD patients. there is,” the authors write. “Our results suggest that perioperative management of patients with COPD requires careful consideration of multiple areas that contribute to increased perioperative risk.”
“Our finding that COPD patients are at risk more than 30 days after surgery suggests that there is value in further supporting the recovery of these patients well beyond one month after surgery.” said Sankar.
shared decision making
Commenting on the Medscape study, Dr. William Warren, an emergency pulmonary specialist at Weill Cornell Medicine in New York City, said: It played a role in the increased mortality seen in this study. “
Dr. William Warren
One caveat, he said, concerns the interpretation of the study’s interaction effects. “Clinicians are less likely to subject frail patients or those with multiple comorbidities to overly complex surgery. Therefore, these effects may be misestimated due to selection bias. .”
After reading the study, two questions remain, he added. “The first is how the degree of obstruction (that is, the severity of COPD) affects long-term mortality. shows the following: Mortality increases with severity of obstructionSecond, how much of the long-term mortality observed in this study is related to respiratory disease due to COPD. Patients with COPD are complex and often die of non-respiratory causes. “
Whalen suggests discussing long-term morbidity and mortality with and without surgical intervention with the surgical team. Such discussions may help share the decision-making process with the patient.
“Several procedures may be required to reduce immediate mortality, such as aortic aneurysm repair. [the risk of] Long-term mortality may be more acceptable in this situation,” he said. [risk] What if that means living without orthopedic pain?”
This research was funded by the Government of Ontario. Sankar and Whalen have not disclosed any related financial relationships.
CMJMorePublished online on January 17, 2023. full text
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