title: Postoperative exacerbation of chronic obstructive pulmonary disease. Does it exist?
abstract: 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.
authors.affiliation: Thoracic Surgery Department, European Institute of Oncology, Milan, Italy. francesco.leo@ieo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Leo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Venissac
authors.forename: Daniel
authors.initials: D
authors.lastname: Pop
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Filosso
authors.forename: Antonio
authors.initials: A
authors.lastname: Minniti
authors.forename: Davide
authors.initials: D
authors.lastname: Radice
authors.forename: Jérôme
authors.initials: J
authors.lastname: Mouroux
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.forename: Ugo
authors.initials: U
authors.lastname: Pastorino
authors.forename: Jacques
authors.initials: J
authors.lastname: Jougon
authors.forename: Jean Francois
authors.initials: JF
authors.lastname: Velly
authors.forename: Alberto
authors.initials: A
authors.lastname: Oliaro
mesh_terms: 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