Postoperative exacerbation of chronic obstructive pulmonary disease. Does it exist?
BACKGROUND
One of the characteristics of chronic obstructive pulmonary disease (COPD) is the tendency to develop acute exacerbation, defined by the presence of different clinical findings as worsening dyspnea, increase in sputum purulence and volume. This study was designed to verify if definition of acute COPD exacerbation is applicable to patients who underwent pulmonary surgery, and if it has any impact on postoperative morbidity and mortality.


METHODS
This study was designed to prospectively enrol 1000 patients undergoing pulmonary resection for lung cancer from five different centres. Postoperative exacerbation of COPD was defined by the concomitant presence of three of the following five signs: deteriorating dyspnea, purulent sputum, bronchial secretion volume >10 ml/24 h, fever without apparent cause, and wheezing. The presence of concomitant pulmonary complications excluded the diagnosis of exacerbation, as they may present one or more of these signs.


RESULTS
In the absence of respiratory complications, postoperative stay in exacerbated patients was significantly longer as compared to patients without exacerbation (6.3+/-1.3 vs 8.3+/-1.1, p=0.001). A postoperative exacerbation of COPD was recorded in 276 patients and 152 of them (55%) subsequently developed respiratory complications. Multivariate analysis established that risk factors for postoperative exacerbation are sex (female OR 0.54, CI 0.2-0.8), COPD class (OR 1.5, CI 1.1-8.1), and the postoperative prolonged use of antibiotics (OR 0.6, CI 0.2-0.9).


CONCLUSIONS
Postoperative exacerbation of COPD is an existing, frequent clinical entity after lung resection and, when present, it increases the risk of pulmonary complications. The existing guidelines for the treatment of acute exacerbation should be adapted for the management of patients after lung resection in order to test the hypothesis that they could reduce respiratory morbidity.
Leo
Francesco
F
Thoracic Surgery Department, European Institute of Oncology, Milan, Italy. francesco.leo@ieo.it
Venissac
Nicolas
N
Pop
Daniel
D
Solli
Piergiorgio
P
Filosso
Pierluigi
P
Minniti
Antonio
A
Radice
Davide
D
Mouroux
Jérôme
J
Spaggiari
Lorenzo
L
Pastorino
Ugo
U
Jougon
Jacques
J
Velly
Jean Francois
JF
Oliaro
Alberto
A
D000208:Acute Disease; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012135:Respiratory Sounds / Q000175:diagnosis