Canada: COPD Study

A recent study in the Canadian Medical Association Journal has revealed that chronic obstructive pulmonary disease (COPD) patients who undergo major surgery are at a higher risk of dying in the year after surgery and incur higher healthcare costs than similar 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," says Dr. Ashwin Sankar, an anesthesiologist at St. Michael's Hospital, a site of Unity Health Toronto, and the University of Toronto.

The study included 932,616 patients aged 35 years and older in Ontario who underwent major surgery, including total hip or knee replacement, gastrointestinal surgery, vascular surgery, and other elective noncardiac surgeries. Of all patients, about 1 in 5 (170,482) had COPD. Patients with COPD were older and more likely to be male, frail, have lower income, and have pre-existing conditions such as coronary artery disease, diabetes, and lung cancers. Researchers found that compared with demographically similar patients without COPD undergoing similar surgery, people with COPD had a 61% increased risk of dying and a 13% increase in healthcare costs in the year after surgery. These increased risks and costs were evident long after the immediate 30-day postoperative period.

Key Findings

• Concerning association with risk of death, COPD had a partially adjusted hazard ratio (HR) of 1.61 and a fully adjusted HR of 1.26.
• Concerning the impact on health system costs, COPD was associated with a partially adjusted relative increase of 13.1% and an increase of 4.6% with full adjustment.
• Frailty, cancer, and procedure type (such as orthopedic and lower abdominal surgery) modified the association between COPD and outcomes.

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

They hope their findings of increased healthcare costs will help policy-makers and hospital administrators with system-level planning to better respond to the postsurgical needs of people with COPD.

Reference

Ashwin Sankar, Kevin Thorpe, Daniel I. McIsaac, Jin Luo, Duminda N. Wijeysundera, and Andrea S. Gershon. CMAJ January 17, 2023 195 (2) E62-E71; DOI: https://doi.org/10.1503/cmaj.220733