Survival and health care costs after inpatient elective surgery: comparison of patients with and without chronic obstructive pulmonary disease.

Humans Cohort Studies Frailty Health Care Costs Inpatients Ontario / epidemiology Pulmonary Disease, Chronic Obstructive / epidemiology Retrospective Studies Elective Surgical Procedures / adverse effects

Journal

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
ISSN: 1488-2329
Titre abrégé: CMAJ
Pays: Canada
ID NLM: 9711805

Informations de publication

Date de publication:
17 01 2023
Historique:
accepted: 07 11 2022
entrez: 17 1 2023
pubmed: 18 1 2023
medline: 20 1 2023
Statut: ppublish

Résumé

Chronic obstructive pulmonary disease (COPD) is common among surgical patients, and patients with COPD have higher risk for complications and death within 30 days after surgery. We sought to describe the longer-term postoperative survival and costs of patients with COPD compared with those without COPD within 1 year after inpatient elective surgery. In this retrospective population-based cohort study, we used linked health administrative databases to identify all patients undergoing inpatient elective surgery in Ontario, Canada, from 2005 to 2019. We ascertained COPD status using validated definitions. We followed participants for 1 year after surgery to evaluate survival and costs to the health system. We quantified the association of COPD with survival (Cox proportional hazards models) and costs (linear regression model with log-transformed costs) with partial adjustment (for sociodemographic factors and procedure type) and full adjustment (also adjusting for comorbidities). We assessed for effect modification by frailty, cancer and procedure type. We included 932 616 patients, of whom 170 482 (18%) had COPD. With respect to association with risk of death, COPD had a partially adjusted hazard ratio (HR) of 1.61 (95% confidence interval [CI] 1.58-1.64), and a fully adjusted HR of 1.26 (95% CI 1.24-1.29). With respect to impact on health system costs, COPD was associated with a partially adjusted relative increase of 13.1% (95% CI 12.7%-13.4%), and an increase of 4.6% (95% CI 4.3%-5.0%) with full adjustment. Frailty, cancer and procedure type (such as orthopedic and lower abdominal surgery) modified the association between COPD and outcomes. Patients with COPD have decreased survival and increased costs in the year after surgery. Frailty, cancer and the type of surgical procedure modified associations between COPD and outcomes, and must be considered when risk-stratifying surgical patients with COPD.

Sections du résumé

BACKGROUND
Chronic obstructive pulmonary disease (COPD) is common among surgical patients, and patients with COPD have higher risk for complications and death within 30 days after surgery. We sought to describe the longer-term postoperative survival and costs of patients with COPD compared with those without COPD within 1 year after inpatient elective surgery.
METHODS
In this retrospective population-based cohort study, we used linked health administrative databases to identify all patients undergoing inpatient elective surgery in Ontario, Canada, from 2005 to 2019. We ascertained COPD status using validated definitions. We followed participants for 1 year after surgery to evaluate survival and costs to the health system. We quantified the association of COPD with survival (Cox proportional hazards models) and costs (linear regression model with log-transformed costs) with partial adjustment (for sociodemographic factors and procedure type) and full adjustment (also adjusting for comorbidities). We assessed for effect modification by frailty, cancer and procedure type.
RESULTS
We included 932 616 patients, of whom 170 482 (18%) had COPD. With respect to association with risk of death, COPD had a partially adjusted hazard ratio (HR) of 1.61 (95% confidence interval [CI] 1.58-1.64), and a fully adjusted HR of 1.26 (95% CI 1.24-1.29). With respect to impact on health system costs, COPD was associated with a partially adjusted relative increase of 13.1% (95% CI 12.7%-13.4%), and an increase of 4.6% (95% CI 4.3%-5.0%) with full adjustment. Frailty, cancer and procedure type (such as orthopedic and lower abdominal surgery) modified the association between COPD and outcomes.
INTERPRETATION
Patients with COPD have decreased survival and increased costs in the year after surgery. Frailty, cancer and the type of surgical procedure modified associations between COPD and outcomes, and must be considered when risk-stratifying surgical patients with COPD.

Identifiants

DOI: 10.1503/cmaj.220733 PMID: 36649951 PMC: PMC9851642
pubmed: 36649951
pii: 195/2/E62
doi: 10.1503/cmaj.220733
pmc: PMC9851642
doi:

Types de publication

Comparative Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

E62-E71

Informations de copyright

© 2023 CMA Impact Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: Daniel McIsaac reports participation on the data safety monitoring board of the PRICE-2 trial. Andrea Gershon reports funding from the Canadian Institutes of Health Research and PSI Foundation, as well as a stipend from Novartis. No other competing interests were declared.

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Auteurs

Ashwin Sankar (A)

Department of Anesthesia (Sankar, Wijeysundera), Unity Health Toronto, St. Michael's Hospital; Department of Anesthesiology and Pain Medicine (Sankar, Wijeysundera), University of Toronto; ICES Central (Sankar, McIsaac, Luo, Wijeysundera, Gershon); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Sankar, Wijeysundera); Dalla Lana School of Public Health (Thorpe, Gershon), University of Toronto; Applied Health Research Centre (AHRC) (Thorpe), Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), University of Ottawa; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Ottawa Hospital Research Institute (McIsaac), Ottawa, Ont.; Division of Respirology, Department of Medicine (Gershon), University of Toronto; Division of Respirology, Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. ashwin.sankar@mail.utoronto.ca.

Kevin Thorpe (K)

Department of Anesthesia (Sankar, Wijeysundera), Unity Health Toronto, St. Michael's Hospital; Department of Anesthesiology and Pain Medicine (Sankar, Wijeysundera), University of Toronto; ICES Central (Sankar, McIsaac, Luo, Wijeysundera, Gershon); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Sankar, Wijeysundera); Dalla Lana School of Public Health (Thorpe, Gershon), University of Toronto; Applied Health Research Centre (AHRC) (Thorpe), Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), University of Ottawa; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Ottawa Hospital Research Institute (McIsaac), Ottawa, Ont.; Division of Respirology, Department of Medicine (Gershon), University of Toronto; Division of Respirology, Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.

Daniel I McIsaac (DI)

Department of Anesthesia (Sankar, Wijeysundera), Unity Health Toronto, St. Michael's Hospital; Department of Anesthesiology and Pain Medicine (Sankar, Wijeysundera), University of Toronto; ICES Central (Sankar, McIsaac, Luo, Wijeysundera, Gershon); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Sankar, Wijeysundera); Dalla Lana School of Public Health (Thorpe, Gershon), University of Toronto; Applied Health Research Centre (AHRC) (Thorpe), Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), University of Ottawa; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Ottawa Hospital Research Institute (McIsaac), Ottawa, Ont.; Division of Respirology, Department of Medicine (Gershon), University of Toronto; Division of Respirology, Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.

Jin Luo (J)

Department of Anesthesia (Sankar, Wijeysundera), Unity Health Toronto, St. Michael's Hospital; Department of Anesthesiology and Pain Medicine (Sankar, Wijeysundera), University of Toronto; ICES Central (Sankar, McIsaac, Luo, Wijeysundera, Gershon); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Sankar, Wijeysundera); Dalla Lana School of Public Health (Thorpe, Gershon), University of Toronto; Applied Health Research Centre (AHRC) (Thorpe), Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), University of Ottawa; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Ottawa Hospital Research Institute (McIsaac), Ottawa, Ont.; Division of Respirology, Department of Medicine (Gershon), University of Toronto; Division of Respirology, Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.

Duminda N Wijeysundera (DN)

Department of Anesthesia (Sankar, Wijeysundera), Unity Health Toronto, St. Michael's Hospital; Department of Anesthesiology and Pain Medicine (Sankar, Wijeysundera), University of Toronto; ICES Central (Sankar, McIsaac, Luo, Wijeysundera, Gershon); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Sankar, Wijeysundera); Dalla Lana School of Public Health (Thorpe, Gershon), University of Toronto; Applied Health Research Centre (AHRC) (Thorpe), Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), University of Ottawa; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Ottawa Hospital Research Institute (McIsaac), Ottawa, Ont.; Division of Respirology, Department of Medicine (Gershon), University of Toronto; Division of Respirology, Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.

Andrea S Gershon (AS)

Department of Anesthesia (Sankar, Wijeysundera), Unity Health Toronto, St. Michael's Hospital; Department of Anesthesiology and Pain Medicine (Sankar, Wijeysundera), University of Toronto; ICES Central (Sankar, McIsaac, Luo, Wijeysundera, Gershon); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Sankar, Wijeysundera); Dalla Lana School of Public Health (Thorpe, Gershon), University of Toronto; Applied Health Research Centre (AHRC) (Thorpe), Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), University of Ottawa; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Ottawa Hospital Research Institute (McIsaac), Ottawa, Ont.; Division of Respirology, Department of Medicine (Gershon), University of Toronto; Division of Respirology, Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.

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