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Abstract
Chronic obstructive pulmonary disease (COPD) is a risk factor of post-operative complications after lung cancer resection. The influence of the “frequent exacerbator (FE)” phenotype (at least three exacerbations per year) is unknown.
Postoperative outcomes of frequent exacerbators (POFE) was a prospective observational study of patients with COPD undergoing lung resection for cancer. The inclusion criteria were: age >40 years, FEV1/FVC <70%, non-urgent surgery for lung cancer, filled out self-questionnaires. The primary outcome was assessment of postoperative pulmonary complications (purulent tracheobronchitis, atelectasis, pneumonia, acute respiratory failure, need of mechanical ventilation). Secondary outcomes encompassed the prevalence of the FE phenotype and its impact on postoperative complications.
A total of 682 patients were screened from June 2014 to October 2015. 93 patients with COPD were included, 21 (23%) were FE. Postoperative tracheobronchitis, atelectasis pneumonia or respiratory failure (isolated or associated) occurred in 47%, 48%, 26%, and 38% of patients, respectively. Non-invasive and invasive mechanical ventilation were necessary in 4 (4%) and 22 (23%) patients. Purulent tracheobronchitis, pneumonia and hypercapnia (this last requiring noninvasive mechanical ventilation) were more frequent in FE (p = 0.043, 0.042, 0.015); however the number of patients wth at least one respiratory complication was not different (76% vs. 52%, p = 0.056). In all patients, multivariate logistic regression identified two independent factors of postoperative respiratory complications: male sex (OR 10.6 [95% CI 1.97–57.6], p = 0.006) and the FE phenotype (OR 6.33 [1.04–38.39], p = 0.045).
Occurrence of postoperative complications in patients with COPD is high. FE phenotype is an independent risk factor.
Disclosure statement
Dr. Roche reports grants and personal fees from Boehringer Ingelheim, Pfizer, Novartis, personal fees from Teva, GSK, AstraZeneca, Chiesi, Mundipharma, Cipla, Sanofi, Sandoz, 3M, Zambon, outside the submitted work.
Additional information
Notes on contributors
Suela Demiri
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Christine Lorut
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Antoine Rabbat
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Daniel Luu van Lang
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Aurelie Lefebvre
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Jean-François Regnard
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Charles-Marc Samama
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Daniel Dusser
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Nicolas Roche
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.
Marco Alifano
SD contributed in article writing, study conception, patient inclusion, statistics, and submission approval. CL contributed in article writing, study conception, patient inclusion, and submission approval. AR, DLVL, AL, JFR, MS and DD are contributed in patient inclusion, submission approval, and manuscript revision. NR contributed in article writing, study conception, and submission approval. MA contributed in article writing, study conception, statistics, and submission approval.