title: Airflow limitation severity and post-operative pulmonary complications following extra-pulmonary surgery in COPD patients.
abstract: 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 (FEV1) and PPC in COPD patients undergoing extra-pulmonary surgery.
  
  
  
  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.
  
  
  
  The overall incidence of PPC was 24.4%. The incidence of PPC in quintiles 1-5 of FEV1(% 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 FEV1(% 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.
  
  
  
  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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Beomsu
authors.initials: B
authors.lastname: Shin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.|Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.|Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea.
authors.forename: Danbee
authors.initials: D
authors.lastname: Kang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Byeong-Ho
authors.initials: BH
authors.lastname: Jeong
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea.
authors.forename: Hyung Koo
authors.initials: HK
authors.lastname: Kang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hae Ri
authors.initials: HR
authors.lastname: Chon
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Man Pyo
authors.initials: MP
authors.lastname: Chung
authors.affiliation: Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.|Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.|Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea.|Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Juhee
authors.initials: J
authors.lastname: Cho
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hye Yun
authors.initials: HY
authors.lastname: Park
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D056910:Republic of Korea; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry; D013514:Surgical Procedures, Operative
chemical_list: D001993:Bronchodilator Agents
keywords: chronic obstructive pulmonary disease; complications; spirometry; surgery