thought objective: To determine the risk of thoracic and major abdominal surgery in patients with chronic obstructive pulmonary disease (COPD) Design: Retrospective cohort cogitation with controls.

thought objective: To determine the risk of thoracic and major abdominal surgery in patients with chronic obstructive pulmonary disease (COPD)

Design: Retrospective cohort cogitation with controls.

Setting: A 692-bed teaching hospital.

Patients: A cohort of 26 patients with simple COPD ([FEV.sub.1] <50 percent predicted) undergoing thoracic and major abdominal surgery was matched through age and type of operation to 52 patients with mild-moderate COPD and 52 patients with no COPD

Measurements and results: The 26 patients with stiff COPD had rates of cardiac, vascular, and minor pulmonary complications similar to patients with mild-moderate COPD and without COPD yet experienced higher rates of serious pulmonary complications (23 percent v 10 percent v 4 percent p = 003) and death (19 percent v 4 percent v 2 percent p = 002) All deaths and instances of ventilatory failure in the patients with censorious COPD occurred in the subset undergoing coronary artery bypass surgery Logistic regression revealed that increased age, higher American society of Anesthesiologists class, an abnormal chest radiograph, and perioperative bronchodilator administration were associated with higher cardiac or serious pulmonary complication rates. Spirometry was not an independent predictor if postoperative complications.

Conclusions: Clinical variables appear better than preoperative spirometry in predicting postoperative cardiopulmonary complications. The utility of preoperative spirometry as well as the benefits of perioperative bronchodilators in patients in stable condition remain to be determined.

Pulmonary disease is typically considered an important risk factor for postoperative complications.[1-3] However, previous studies report primarily an increased incidence of atelectasis, transient dyspnea or cough and other self-limited events[4-11] Ventilatory failure and death have been extraordinary in case series of operations in patients with inexorable chronic obstructive pulmonary disease (COPD)[12-16] and in a late cohort study, we established that noncardiac surgery can safely be performed in patients with inexorable COPD.[17]

The emblem of operation is considered a critical determinant of pulmonary risk. Obviously, managements that involve resection of pulmonary tissue carry the greatest risk, even now nonresectional thoracic and upper abdominal operations are to a great degree more commonly performed and are also considered high risk for pulmonary complications. What is not clear is by what means much additional risk is pos by dint of the presence of COPD in patients undergoing these marks of operation. Previous evidence allude tos that the severity of airways obstruction as measured by means of spirometry may not be an independent predictor of pulmonary complications level in these high-risk procedures.[18-20]

To determine the efficiency of obstructive airways disease upon complication rates following thoracic and upper abdominal operations, we compared patients with bitter COPD to two control disposes matched by age and procedure: patients with mild to moderate COPD and patients with normal pulmonary function. Because these steps are also associated with an increased risk of cardiac complications, we examined the incidence of the pair postoperative pulmonary and cardiac events

METHODS

The inquiry site was Brooke Army Medical Center a 692-bed teaching hospital in Texas that helps active-duty and retired military personnel and their pendents From 107 elective operations performed in patients with hard COPD at Brooke between January 1986 and September 19881' we focused in succession the 31 nonresectional thoracic and major abdominal steps In 26 of these, we had without fault [i]or[/i] blemish [i]or[/i] flaw hospital records and for 5 detailed narrative summaries. These latter five patients had been transferred back to their regional military medical facility following surgery and their records had accompanied them. Although these five transferred patients could not he included in the detailed analysis involving the sum of two units comparison groups, none died or discloseed ventilatory failure, so that their inclusion would not have strengthened the association between peremptory COPD and postoperative pulmonary complications.

The pair comparison groups were randomly preferableed from the log of all patients undergoing preoperative spirometry during the research period. For each of the 26 patients with exact COPD, two patients with mild to moderate obstruction and couple patients vath no obstruction were culled with matching on the basis of age (within a decade) and stamp of operative procedure. Using propos criteria[21] as a guide, we defined airways obstruction as follows: relentless - [FEV.sub.1] < 50 percent of predicted and [FEVsub1]/FVC < 70 percent; mild-moderate - [FEVsub1] from 50 percent to 79 percent of predicted and [FEVsub1]/FVC of < 70 percent; and normal - [FEVsub1] [greater than or equal to] 80 percent of predicted and [FEVsub1]/FVC [greater or equal to] 70 percent Not eligible for this cogitation were individuals with a normal [FEVsub1]/FVC however low [FEV.sub.1] percent of predicted (ie, restrictive defect) and those with a reasonable [FEV.sub.1]/FVC but normal [FEV.sub.1] percent of predicted.

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