Airflow limitation severity and post‐operative pulmonary complications following extra‐pulmonary surgery in COPD patients

Abstract

Background and objective: The association between airflow limitation severity and post-operative pulmonary complications (PPCs) among COPD patients undergoing extra-pulmonary surgery is unknown. We evaluated the association between forced expiratory volume in 1 s (FEV 1 ) and PPC in COPD patients undergoing extra-pulmonary surgery. Methods: Using prospective cohort of PPC evaluation for extra-pulmonary surgery, we identified 694 COPD patients who conducted PPC evaluation before extrapulmonary surgery between March 2014 and January 2015 at a tertiary hospital, Seoul, Korea. Results: The overall incidence of PPC was 24.4%. The incidence of PPC in quintiles 1-5 of FEV 1 (% predicted) was 31.4, 25.8, 23.7, 21.6 and 19.7%, respectively (P for trend: 0.019). In fully adjusted multivariable models, the relative risks (RRs, 95% CI) for PPC comparing participants in quintiles 1-4 of FEV 1 (% predicted) with those in quintile 5 were 1.69 (1.03-2.79), 1.41 (0.83-2.37), 1.26 (0.75-2.11) and 1.30 (0.76-2.22), respectively (P for trend: 0.046). The association of severe airflow limitation with respiratory failure and post-operative exacerbations was stronger in participants who did not use bronchodilators compared with those who did. Conclusion: We found a progressive and significant relationship between severity of airflow limitation and the incidence of PPC in COPD patients undergoing extra-pulmonary surgery. Furthermore, perioperative bronchodilator use was associated with a reduced risk

Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

“…We initially screened 1106 patients with COPD who underwent preoperative consultations with respiratory physicians and were registered in our institutional, prospectively collected PPC database between March 2014 and January 2015 [14]. We excluded 64 patients with bronchial asthma, determined by Shin SH and Im Y based on the patients' medical history with further confirmation by Park HY.…”

Year in review 2017: Chronic obstructive pulmonary disease and asthma

“…16,31 A systematic review of the impact of inhaled corticosteroid treatment on the risk of lung cancer in COPD by Raymakers et al 32 found that randomized studies demonstrated no evidence of benefit, although descriptive studies showed some protection at high doses. Finally, a prospective cohort study by Shin et al 4 reported post-operative respiratory complications in nearly 25% of COPD patients following extra-pulmonary surgery. These complications were related to the severity of airflow obstruction and may have been prevented by perioperative use of bronchodilator therapy.…”

“…found that randomized studies demonstrated no evidence of benefit, although descriptive studies showed some protection at high doses. Finally, a prospective cohort study by Shin et al . reported post‐operative respiratory complications in nearly 25% of COPD patients following extra‐pulmonary surgery.…”

“…reported post‐operative respiratory complications in nearly 25% of COPD patients following extra‐pulmonary surgery. These complications were related to the severity of airflow obstruction and may have been prevented by perioperative use of bronchodilator therapy …”

“…Specifically, they have greater risk for post‐operative respiratory complications that increases with age . In 2017, evidence was published in Respirology demonstrating that bronchodilator use can prevent or minimize the onset of respiratory complications following non‐pulmonary surgery . If such complications can be prevented, this will have not only a major impact on length of stay and costs, but also on quality of life.…”