COPD Lowers Chances of Survival and Raises Health Care Costs After Surgery, Study Finds

A study found that patients with a diagnosis of chronic obstructive pulmonary disease (COPD) were 61% more likely to die in the year following surgery and had a 13% increase in health care costs after surgery, compared with patients without COPD.

"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," Ashwin Sankar, MD, MSc, FRCPC, an anesthesiologist at St. Michael's Hospital, a site of Unity Health Toronto, and the University of Toronto, said in a statement.

This retrospective population-based cohort study examined longer-term postoperative survival and health care costs of patients with COPD compared with those without COPD. The results were published in the Canadian Medical Association Journal (CMAJ).

The researchers identified a total of 932,616 patients aged 35 years or older living in Ontario, Canada, who underwent certain intermediate-to-high-risk inpatient elective non-cardiac surgeries from 2005 to 2019, including total hip or knee replacement, gastrointestinal surgery, vascular surgery, etc.

The researchers followed participants for 1 year after surgery to evaluate survival rates and health care costs. Sociodemographic factors were factored into the analysis. Frailty, cancer, and procedure type modified the association between COPD and outcomes.

Past estimates have suggested that more than 10% of surgical patients have COPD. In this study, out of all the patients identified, about 1 in 5 (170,482) had COPD. These patients tended to be older (aged 62-78), male, frail, have lower income, and have pre-existing conditions such as coronary artery disease, diabetes, and lung cancers.

Patients with COPD were 61% more likely to die (n = 5873, 3.4%) than those without COPD (n = 9429, 1.2%) within the year after surgery. COPD had a partially adjusted hazard ratio (HR = 1.61; 95% CI, 1.58-1.64), and a fully adjusted hazard ratio (HR = 1.26; 95% CI, 1.24-1.29).

Furthermore, 52,021 (5.6%) of patients died the year after surgery, including 18,007 (10.6%) of patients with COPD and 34,014 (4.5%) of patients without COPD.

Additionally, COPD was associated with a partially adjusted relative increase 13.1% (95% CI, 12.7%-13.4%) in health care costs, and an increase of 4.6% (95% CI, 4.3%-5.0%) with a full adjustment.

The researchers acknowledged that identifying patients who underwent surgery may have led to bias in their results, and advocated for further studies to measure and define severe COPD in patients.

Overall, this study suggests that patients with COPD have higher risk of death and higher health care costs within the year after undergoing surgery. Furthermore, the greater risk and cost associated with COPD was found to extend well beyond the immediate 30-day perioperative period, and is affected by frailty, cancer, and types of surgeries, suggesting a need for better management of postsurgical care for patients with COPD.

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

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. Canadian Medical Association Journal. 2023;195(2). doi:10.1503/cmaj.220733