title: Impact of COPD on postoperative outcomes: results from a national database.
abstract: BACKGROUND
  Although COPD affects large sections of the population, its effects on postoperative outcomes have not been rigorously studied. The objectives of this study were to describe the prevalence of COPD in patients undergoing surgery and to analyze the associations between COPD and postoperative morbidity, mortality, and hospital length of stay.
  
  
  METHODS
  Patients with COPD who underwent surgery were identified from the National Surgical Quality Improvement Program database (2007-2008). Univariate and multivariate analyses were performed on this multicenter, prospective data set (N = 468,795).
  
  
  RESULTS
  COPD was present in 22,576 patients (4.82%). These patients were more likely to be older, men, white, smokers, and taking corticosteroids and had a lower BMI (P &lt; .0001 for each). Median length of stay was 4 days for patients with COPD vs 1 day in those without COPD (P &lt; .0001). Thirty-day morbidity rates were 25.8% and 10.2% for patients with and without COPD, respectively (P &lt; .0001). Thirty-day death rates were 6.7% and 1.4% for patients with and without COPD, respectively (P &lt; .0001). After controlling for &gt; 50 comorbidities through logistic regression modeling, COPD was independently associated with higher postoperative morbidity (OR, 1.35; 95% CI, 1.30-1.40; P &lt; .0001) and mortality (OR, 1.29; 95% CI, 1.19-1.39; P &lt; .0001). Multivariate analyses with each individual postoperative complication as the outcome of interest showed that COPD was associated with increased risk for postoperative pneumonia, respiratory failure, myocardial infarction, cardiac arrest, sepsis, return to the operating room, and renal insufficiency or failure (P &lt; .05 for each).
  
  
  CONCLUSIONS
  COPD is common among patients undergoing surgery and is associated with increased morbidity, mortality, and length of stay.
authors.affiliation: Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI.
authors.forename: Himani
authors.initials: H
authors.lastname: Gupta
authors.affiliation: Department of Surgery, Creighton University, Omaha, NE.
authors.forename: Bala
authors.initials: B
authors.lastname: Ramanan
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI. Electronic address: pgupta@uwhealth.org.
authors.forename: Prateek K
authors.initials: PK
authors.lastname: Gupta
authors.affiliation: Department of Biostatistical Core, Creighton University, Omaha, NE.
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Medicine, Creighton University, Omaha, NE.
authors.forename: Ann
authors.initials: A
authors.lastname: Polich
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Creighton University, Omaha, NE.
authors.forename: Ariel
authors.initials: A
authors.lastname: Modrykamien
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Creighton University, Omaha, NE.
authors.forename: Dan
authors.initials: D
authors.lastname: Schuller
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Creighton University, Omaha, NE.
authors.forename: Lee E
authors.initials: LE
authors.lastname: Morrow
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D014481:United States / Q000453:epidemiology