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Impact of COPD on postoperative outcomes: results from a national database.
Chest 2013; 143(6):1599-1606Chest

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.

Authors+Show Affiliations

Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI.Department of Surgery, Creighton University, Omaha, NE.Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI. Electronic address: pgupta@uwhealth.org.Department of Biostatistical Core, Creighton University, Omaha, NE.Department of Medicine, Creighton University, Omaha, NE.Division of Pulmonary, Critical Care and Sleep Medicine, Creighton University, Omaha, NE.Division of Pulmonary, Critical Care and Sleep Medicine, Creighton University, Omaha, NE.Division of Pulmonary, Critical Care and Sleep Medicine, Creighton University, Omaha, NE.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

23287892

Citation

Gupta, Himani, et al. "Impact of COPD On Postoperative Outcomes: Results From a National Database." Chest, vol. 143, no. 6, 2013, pp. 1599-1606.
Gupta H, Ramanan B, Gupta PK, et al. Impact of COPD on postoperative outcomes: results from a national database. Chest. 2013;143(6):1599-1606.
Gupta, H., Ramanan, B., Gupta, P. K., Fang, X., Polich, A., Modrykamien, A., ... Morrow, L. E. (2013). Impact of COPD on postoperative outcomes: results from a national database. Chest, 143(6), pp. 1599-1606. doi:10.1378/chest.12-1499.
Gupta H, et al. Impact of COPD On Postoperative Outcomes: Results From a National Database. Chest. 2013;143(6):1599-1606. PubMed PMID: 23287892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of COPD on postoperative outcomes: results from a national database. AU - Gupta,Himani, AU - Ramanan,Bala, AU - Gupta,Prateek K, AU - Fang,Xiang, AU - Polich,Ann, AU - Modrykamien,Ariel, AU - Schuller,Dan, AU - Morrow,Lee E, PY - 2013/1/5/entrez PY - 2013/1/5/pubmed PY - 2013/8/21/medline SP - 1599 EP - 1606 JF - Chest JO - Chest VL - 143 IS - 6 N2 - 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. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/23287892/Impact_of_COPD_on_postoperative_outcomes:_results_from_a_national_database_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(13)60388-8 DB - PRIME DP - Unbound Medicine ER -