title: Surgical outcomes in patients with chronic obstructive pulmonary disease undergoing abdominal operations: An analysis of 331,425 patients.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) affects >15 million individuals in the United States and is a common comorbidity in patients undergoing surgery; therefore, the association between COPD in patients and postoperative surgical outcomes was investigated. The objective of this study was to assess the associations between COPD and postoperative morbidity, mortality, and hospital duration of stay.
  
  
  METHODS
  Patients who underwent cholecystectomy, appendectomy, small bowel resection, partial colectomy, hepatic resection, gastrectomy, pancreatectomy, and ventral hernia repair with and without COPD (n = 331,425) in the National Surgical Quality Improvement Program database from 2007 to 2010 were studied. The primary outcomes were 30-day morbidity, mortality, and hospital duration of stay; secondary outcomes were specific postoperative complications.
  
  
  RESULTS
  COPD was present in 12,491 patients (3.8%) undergoing the abdominal operations surveyed. The 30-day morbidity and mortality rates and hospital duration of stay for patients undergoing all abdominal procedures reviewed was greater for patients with COPD compared with patients without COPD (all P < .0001, except hepatic resection). Multivariate analysis controlling for comorbidities revealed that COPD was associated independently with increased postoperative morbidity in all abdominal procedures reviewed, increased postoperative mortality after cholecystectomy, appendectomy, small bowel resection, and ventral hernia repair, and increased duration of stay after cholecystectomy, small bowel resection, partial colectomy, gastrectomy, pancreatectomy, and ventral hernia repair (all P < .05).
  
  
  CONCLUSIONS
  Patients with COPD undergoing operative procedures in the abdomen have increased morbidity, mortality, and duration of stay. This study highlights the importance of studying potential preoperative optimization of pulmonary status in patients with COPD before operation.
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Fields
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Celia.Divino@mountsinai.org.
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States