Surgery brings additional risks for people with COPD

By Steven Reinberg Health Day Reporter

TUESDAY, Jan. 17, 2023 (HealthDay News) — Major surgery is a challenge for people with chronic obstructive pulmonary disease (COPD), increasing their risk of dying within a year by 61 percent, new research shows.

The researchers also found that these patients incurred 13% higher healthcare costs in the year following their surgery, compared to patients without respiratory conditions.

“These increased risks and costs were evident long after the immediate 30-day postoperative period,” the lead researcher said. Dr Ashwin Sankarclinician researcher in anesthesiology at the University of Toronto, Canada.

The study quantifies additional risks faced by patients with COPD that doctors should discuss before surgery, he said.

“Informing patients of the risk of surgery is an important part of the informed consent process prior to surgery. We suggest that clinicians and patients weigh these risks when deciding whether to proceed with surgery,” Sankar explained.

This study cannot prove that COPD caused the deaths after surgery because most COPD patients had other chronic health conditions, which could have contributed to the results.

“What we suggest to clinicians is to use COPD as an indicator of other conditions and ensure that modifiable risk factors are optimized prior to surgery,” Sankar said.

Additionally, since COPD patients are at risk beyond 30 days after surgery, it may be helpful to support the recovery of these patients beyond the first month after surgery, he added.

In the United States, about 16 million people have COPD, according to the United States Centers for Disease Control and Prevention. COPD includes a group of diseases, including emphysema and chronic bronchitis, that block airflow and restrict breathing.

For the study, Sankar and his colleagues collected data on nearly 933,000 patients who underwent major surgery, including total hip or knee replacement surgery, gastrointestinal surgery, vascular surgery or other elective operations. Over 170,000 of these patients had COPD.

COPD patients were older, more likely to be male, frail, low-income and had pre-existing conditions, such as heart disease, diabetes and lung cancer, the researchers noted.

dr. Mangala Narasimhan is senior vice president of critical care services at Northwell Health in New Hyde Park, NY “It makes sense that after surgery these patients would have more complications,” she said.

“The advice for doctors is to consider the need for surgery and advise patients that there is a higher risk of complications, and that patients at least know that this allows them to make informed decisions,” said she added.

Narasimhan’s advice to anyone with COPD is, number one, not to smoke. “Smoking leads to increased risks of many other things in the future,” she said. “If you smoke, quit as soon as possible. Even if you quit later in life, there are definitely benefits.”

Additionally, she said patients should determine if surgery is needed.

“No surgery is without risk,” Narasimhan said. “For these patients, it’s much more risky and they should consider that before embarking on a procedure.” Of course, some surgeries cannot be avoided, she acknowledged.

If you are going to have major surgery, Narasimhan advises getting any health issues under control beforehand. This includes COPD, diabetes, lung cancer or heart disease.

“The only advice is not to ignore the underlying risks. They will catch up with you, so optimize your health before you have surgery,” she said.

Narasimhan said your doctor might even put the surgery on hold until your health is at its best.

SOURCES: Ashwin Sankar, MD, clinician scientist, anesthesiology, University of Toronto, Canada; Mangala Narasimhan, DO, senior vice president, critical care services, Northwell Health, New Hyde Park, NY; CMAJ (Journal of the Canadian Medical Association)January 17, 2023

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