Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of death and higher medical costs if they undergo surgery than similar patients without COPD, according to a new study.
Findings from a new study published in Journal of the Canadian Medical Association COPD was associated with a 61% increased risk of death and a 13% increase in total costs 1 year after surgery after adjusting for sociodemographic factors and type of surgery .
COPD is common among surgical patients and patients. COPD According to researchers at the University of Toronto, Ontario, there is an increased risk of complications and death within 30 days of surgery.
“Understanding the long-term outcomes of surgical patients with COPD is critical to accurately guide informed consent discussions and predict need for care. “Clarifying these costs will facilitate system-level budgeting and resource allocation,” the study authors wrote.
The research team included patients aged 35 years and older who underwent hip or knee replacement, gastrointestinal surgery, vascular surgery, and other intermediate-to-intermediate surgeries between March 2005 and March 2019 in Ontario. We conducted a retrospective, population-based cohort study of 932,616 patients with . – High-risk elective non-cardiac surgery.
The researchers quantified the association between COPD and survival and health care costs, partially adjusted (for sociodemographic factors and type of treatment) and fully adjusted (also adjusted for comorbidities). They assessed modification of efficacy by vulnerability, cancer, and treatment type.
Of the total study participants, 170,482 (18.3%) were physicians diagnosed with COPD. Participants with COPD were older and more often male than participants without COPD, were in his lower-income quintile, were in long-term care, and had been hospitalized before surgery. rice field. Adults with COPD were also more likely than adults without COPD to have other pre-existing conditions such as coronary artery disease, congestive heart failure, and lung cancer.
Study results showed that within 30 days after surgery, COPD patients had an increased risk of all-cause mortality, with an unadjusted hazard ratio (HR) of 2.45 (95% CI 2.41-2.50) and a partially adjusted HR of 1.61. . (95% CI 1.58-1.64), fully adjusted HR 1.26 (95% CI 1.24-1.29).
With regard to impact on health care costs, COPD patients had 13.1% ((95% CI 12.7–13.4)) higher total costs with partial adjustment and 4.6% (95% CI 4.3–5.0) higher total costs with full adjustment.
Researchers found that vulnerability, cancer, and type of surgery changed the association between COPD and outcome.
The researchers noted that because they defined the cohort by identifying those who underwent surgery, patients with more severe COPD may not have been offered surgery, which could lead to selection bias. bottom. “Although possible, the current perioperative evidence does not preclude elective noncardiothoracic surgery for COPD alone. The feasibility may be limited,” the authors write.
The study also did not include a measure of COPD severity, and further work is needed to develop a definition of severe COPD that predicts an increased risk of postoperative complications, the study authors added. rice field.
“Perioperative patient care must include comprehensive assessment and treatment tailored not only for COPD, but also for the management of concomitant conditions and surgical disease,” the researchers concluded.
References: Sankar A, Thorpe K, McIsaac DI, Luo J, Wijeysundera DN, Gershon AS. Survival and health care costs after elective surgery: a comparison of patients with and without chronic obstructive pulmonary disease.CMAJ2023;195:E62-E71.