Major surgery risk for COPD patients

Matt Woodley

17/01/2023 5:45:37 PM

People with COPD are significantly more likely to die in the year after a surgical procedure than otherwise similar patients, new research has found.

Surgical procedure
People with COPD often have significant comorbidities that puts them at greater post-surgical risk of adverse outcomes.

A new Canadian study has found patients with chronic obstructive pulmonary disease (COPD) who undergo major surgery are much more likely to die in the year following the procedure than those who do not have the disease.
The research, published in the Canadian Medical Association Journal, tracked 932,616 patients aged 35 years and older for 12 months after they underwent major surgery, including total hip or knee replacement, gastrointestinal surgery, vascular surgery and other elective non-cardiac surgeries.
Approximately one in five patients (18.3%) involved in the study had COPD, and researchers found that they were 61% more likely to die in the year after surgery than demographically similar patients without COPD who underwent comparable procedures.
These increased risks – and the 13% increase in healthcare costs for people with COPD – were evident long after the immediate 30-day postoperative period, the researchers said.
Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory, told newsGP the research highlights the multiple comorbidities and significantly increased frailty that people with COPD often have, which puts them at greater post-surgical risk of adverse outcomes.
‘This is often essential surgery to improve quality of life, improve function, or deal with cancer, and our patients with COPD deserve the opportunity to embark on such procedures,’ she said.
‘But it is important for us as primary care clinicians who care for these patients to consider the clinical implications of these findings.
‘Patients with COPD need to be aware of these increased risks when embarking on such intermediate- to high-risk elective procedures.’
Dr Ashwin Sankar, an anaesthesiologist at St Michael’s Hospital and the University of Toronto, provided similar advice.
‘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,’ he said.
And while the study is based in Canada, Dr Hancock believes Australian data would be similar, ‘considering the estimated prevalence of COPD is about one in 14 generally but rising to potentially one in three in over-75s’.
She also pointed out that increased frailty was identified as a ‘huge independent risk factor’, even though it is something that can often be overlooked.
‘I feel that as GPs we could be more proactive in identifying and managing frailty – sooner than later – in not only our very elderly patients, which we are great at doing, but also in all our patients with COPD, regardless of age,’ Dr Hancock said.
‘Managing the frailty will assist in at least attempting to decrease that risk of surgery in our patients with COPD, when and if it is needed, and give them the best chance of a good outcome.’ 
Dr Hancock suggests referring COPD patients with frailty to pulmonary rehabilitation, or if that is not available, supervised home-based programs or other options, such as Strength for Life.
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