Airflow limitation severity and post‐operative pulmonary complications following extra‐pulmonary surgery in <scp>COPD</scp> patients

Abstract

ABSTRACT Background and objective The association between airflow limitation severity and post‐operative pulmonary complications ( PPCs ) among COPD patients undergoing extra‐pulmonary surgery is unknown. We evaluated the association between forced expiratory volume in 1 s ( FEV 1 ) and PPC in COPD patients undergoing extra‐pulmonary surgery. Methods Using prospective cohort of PPC evaluation for extra‐pulmonary surgery, we identified 694 COPD patients who conducted PPC evaluation before extra‐pulmonary surgery between March 2014 and January 2015 at a tertiary hospital, Seoul, Korea. Results The overall incidence of PPC was 24.4%. The incidence of PPC in quintiles 1–5 of FEV 1 (% predicted) was 31.4, 25.8, 23.7, 21.6 and 19.7%, respectively ( P for trend: 0.019). In fully adjusted multivariable models, the relative risks ( RRs , 95% CI ) for PPC comparing participants in quintiles 1–4 of FEV 1 (% predicted) with those in quintile 5 were 1.69 (1.03–2.79), 1.41 (0.83–2.37), 1.26 (0.75–2.11) and 1.30 (0.76–2.22), respectively ( P for trend: 0.046). The association of severe airflow limitation with respiratory failure and post‐operative exacerbations was stronger in participants who did not use bronchodilators compared with those who did. Conclusion We found a progressive and significant relationship between severity of airflow limitation and the incidence of PPC in COPD patients undergoing extra‐pulmonary surgery. Furthermore, perioperative bronchodilator use was associated with a reduced risk of respiratory failure and post‐operative exacerbations in patients with severe airflow limitation.