Patients with COPD face high mortality risk, costs in year after surgery

One year after surgery, patients with COPD had a greater risk for mortality and higher health care costs than those without COPD, according to a study published in Canadian Medical Association Journal.

Ashwin Sankar

“A big take-away from this study is that these patients are at increased risk of death and incur higher health care costs beyond 30 days after surgery,” Ashwin Sankar, MD, MSc, FRCPC, clinician-investigator in anesthesiology and perioperative medicine at St. Michael’s Hospital and University of Toronto, told Healio. “Other studies of outcomes in patients who undergo surgery have typically focused on the first 30 days, and this outcome may not adequately capture the overall burden of surgery and how long it may take patients to recover.”

In a retrospective population-based cohort study, Sankar and colleagues used linked health administrative databases to evaluate 932,616 patients (median age, 65 years; 59.9% women) aged 35 years or older undergoing an elective noncardiac surgery in Ontario from 2005 to 2019, including 170,482 (18.3%) patients with COPD. They used Cox proportional hazard models to determine differences in survival and a linear regression model with log-transformed costs to determine differences in health system costs 1 year after surgery between patients with and without COPD.

Of the total cohort, a greater percentage of patients with COPD died within the 1-year study period (10.6% vs. 4.5%) and within 30-days after surgery (3.4% vs. 1.2%) than those without COPD.

Compared with those without COPD, those with COPD had a higher risk for death in models partially adjusted for sociodemographic factors and procedure type (adjusted HR = 1.61; 95% CI, 1.58-1.64) and fully models that additionally considered comorbidities (aHR = 1.26; 95% CI, 1.24-1.29).

Further, patients with COPD had 13.1% (95% CI, 12.7%-13.4%) greater total health care costs in partially adjusted models and 4.6% (95% CI, 4.3%-5%) greater total costs in fully adjusted models.

Depending on the type of surgical procedure, the impact of COPD on cost differed; researchers noted that cost for these patients was greater after orthopedic and lower abdominal surgery.

Researchers also found that frailty, cancer and procedure type altered the association between COPD and outcomes.

“As a follow-up to this study, we are currently working on identifying whether there are subsets of COPD patients or specific features of COPD which make certain patients high risk for complications after surgery,” Sankar told Healio. “This work would also be informative to clinicians on which patients require further assessment prior to surgery, and potentially also need additional support after surgery.”

Because these findings impact the everyday clinician, Sankar told Healio a few things they should keep in mind when treating patients with COPD.

“First, our study quantifies the additional risks faced by patients with COPD,” he said. “Informing patients of risk of surgery is an important component of the informed-consent process prior to surgery. We would suggest that clinicians and patients weigh these risks when deciding to proceed with surgery.

“Next, we found that COPD often coexists with other conditions like diabetes, coronary artery disease and frailty. What we would suggest to clinicians is to use COPD as a flag for other conditions, and to ensure that modifiable risk factors are optimized prior to surgery,” Sankar continued. “Lastly, our finding that patients with COPD are at risk beyond 30 days after surgery suggests that it may be worthwhile to additionally support these patients' recovery beyond the first month after surgery.”

For more information:

Ashwin Sankar, MD, MSc, can be reached at ashwin.sankar@mail.utoronto.ca.

Reference:

• COPD patients 61% more likely to die in the year after major surgery. https://www.eurekalert.org/news-releases/976217. Published Jan. 17, 2023. Accessed Jan. 17, 2023.