In a study from St. Michael’s Hospital and elsewhere, scientists found people with chronic obstructive pulmonary disease (COPD) who undergo major surgery are more likely to die in the year after surgery and incur higher healthcare costs than similar patients without COPD.
The findings suggest that patients with COPD are often frail and have many health problems, therefore their management around the time of surgery should address not only COPD but all their health issues.
In the study, the team examined 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.
Among 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.
The 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 health care costs in the year after surgery.
These increased risks and costs were evident long after the immediate 30-day postoperative period.
The team says patients with COPD typically have concurrent comorbidity, biopsychosocial issues and frailty.
The findings highlight the importance of careful risk prediction and decision-making for patients with COPD who are considering surgery.
The researchers hope that their findings of increased healthcare costs will help with system-level planning by policy-makers and hospital administrators to better respond to the postsurgical needs of people with COPD.
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The study was conducted by Dr. Ashwin Sankar et al and published in CMAJ (Canadian Medical Association Journal).
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