Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications

Figures & data

Table 1 Baseline characteristics of study patients

Variables	Patients without postoperative complications, n=335	Patients with postoperative complications, n=70	P-value
Agea	70 (46–91)	71 (44–88)	0.841
Male sex	281 (83.9)	66 (94.3)	0.024
BMI (kg/m^2)b	23.51±2.90	22.44±3.18	0.006
Smoking history	239 (71.3)	64 (91.4)	<0.001
Underlying disease
Hypertension	172 (51.3)	34 (48.6)	0.673
Diabetes mellitus	64 (19.1)	14 (20.0)	0.863
Tuberculosis	37 (11.0)	4 (5.7)	0.179
Liver disease	33 (9.9)	10 (14.3)	0.273
Heart disease	46 (13.7)	9 (12.9)	0.846
Renal disease	16 (4.8)	4 (5.7)	0.761
Neurologic disease	37 (11.0)	10 (14.3)	0.441
Malignancy	158 (47.2)	47 (67.1)	0.002
ASA physical status			0.998
1	38 (11.3)	8 (11.4)
2	269 (80.3)	56 (80.0)
3	28 (8.4)	6 (8.6)
PFT values
FVC, % predictedb	103.64±15.86	102.10±15.63	0.461
FEV1, % predictedc	94 (84–106)	90 (94.5–102.25)	0.044
FEV1/FVC, %c	64 (59–67)	63 (53.5–68)	0.226

Notes: Data are presented as numbers (%) unless otherwise indicated.

a Median (range),

b mean ± SD,

c median (interquartile range).

Abbreviations: BMI, body mass index; ASA, American Society of Anesthesiologists; PFT, pulmonary function test; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.

Table 2 Types of postoperative complications

Category	Postoperative complication	n (%)
Pulmonary		20 (4.9)
	Pneumonia	11 (2.7)
	Pleural effusion	9 (2.2)
	Atelectasis	4 (1.0)
Infection		22 (5.4)
	Organ specific infection	19 (4.7)
	Bloodstream infection	3 (0.7)
	Septic shock	1 (0.2)
Renal		6 (1.5)
	Acute kidney injury	6 (1.5)
	Dialysis	2 (0.5)
Cardiac		4 (1.0)
	Arrhythmia	4 (1.0)
Wound		27 (6.7)
	Major	17 (4.2)
	Minor	10 (2.5)
Others		13 (3.2)
	Acute urinary retention	7 (1.7)
	Delirium	6 (1.5)

Note: More than one postoperative complication could occur in each patient.

Table 3 Surgical information of patients with and without complications

Variables	Patients without postoperative complications, n=335	Patients with postoperative complications, n=70	P-value
Surgery site
Brain	13 (3.9)	0 (−)	0.137
Head and neck	44 (13.1)	3 (4.3)	0.036
Thorax	8 (2.4)	6 (8.6)	0.021
Upper abdomen	54 (16.1)	29 (41.4)	<0.001
Lower abdomen	36 (10.7)	9 (12.9)	0.675
Genitourinary	94 (28.1)	11 (15.7)	0.032
Orthopedic	45 (13.4)	7 (10.0)	0.435
General anesthesia	268 (80.0)	69 (98.6)	<0.001
Emergency operation	7 (2.1)	0 (−)	0.610
Anesthesia time (hours)a	1.92 (1.17–3.33)	4.62 (3.17–5.83)	<0.001
EBL (L)a	0.02 (0.00–0.15)	0.40 (0.15–0.96)	<0.001

Notes: Data are presented as numbers (%) unless otherwise indicated.

a Median (interquartile range).

Abbreviation: EBL, estimated blood loss.

Table 4 Distribution of postoperative complications based on the COPD group

Comparison	Patients without complications, n=335	Patients with complications, n=70	P-value
GOLD gradea			0.020
1	272 (81.2)	48 (68.6)
2	54 (16.1)	17 (24.3)
3	9 (2.7)	4 (5.7)
4	0 (−)	1 (1.4)
GOLD group			0.056
A	210 (62.7)	41 (58.6)
B	110 (32.8)	20 (28.6)
C	7 (2.1)	4 (5.7)
D	8 (2.4)	5 (7.1)
Risk assessment			0.047
Low risk (A or B)	319 (95.2)	62 (88.6)
High risk (C or D)	16 (4.8)	8 (11.4)
Level of symptoms			>0.999
Less symptoms (A or C)	217 (64.8)	45 (64.3)
More symptoms (B or D)	118 (35.2)	25 (35.7)

Notes: Data are presented as numbers (%).

a GOLD grade is defined as: 1, FEV₁ ≥80% predicted; 2, 50% ≤ FEV₁ <80% predicted; 3, 30% ≤ FEV₁ <50% predicted; 4, FEV₁ <30% predicted.

Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 5 Multivariable analysis for factors related to postoperative complications

Variables	OR	95% CI	P-value
High-risk groupa	4.023	1.312–12.335	0.015
Male sex	0.620	0.134–2.871	0.541
BMI (kg/m^2)	0.962	0.864–1.072	0.484
Smoking history	6.079	1.704–21.687	0.005
Underlying malignancy	1.112	0.552–2.243	0.766
Thoracic surgery	2.069	0.555–7.714	0.279
Upper abdominal surgery	1.883	0.927–3.827	0.080
Estimated blood loss (L)	1.788	1.076–2.972	0.025
General anesthesia	4.547	0.566–36.541	0.154
Anesthesia time (hours)	1.445	1.205–1.732	<0.001

Note:

a GOLD groups C or D.

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table S1 Multivariate analysis of postoperative pulmonary complications, infection, and wound complications

Variables	OR	95% CI	P-value
Postoperative pulmonary complicationa
High-risk groupb	1.103	0.187–6.510	0.914
Upper abdominal surgery	3.155	1.208–8.238	0.019
EBL (L)	1.591	1.051–2.409	0.028
Postoperative infectionc
High-risk groupb	3.755	1.053–13.387	0.041
BMI (kg/m^2)	0.847	0.727–0.987	0.034
EBL (L)	1.909	1.285–2.836	0.001
Postoperative wound complicationd
High-risk groupb	5.883	1.642–21.082	0.007
EBL (L)	1.593	1.014–2.503	0.043
Smoking history	11.532	1.393–95.472	0.023
Upper abdominal surgery	3.846	1.607–9.209	0.002

Notes:

a Adjusted for underlying heart disease, underlying malignancy, upper abdominal surgery, EBL, and general anesthesia;

b GOLD groups C and D;

c adjusted for BMI, underlying malignancy, upper abdominal surgery, EBL, and general anesthesia;

d adjusted for BMI, underlying malignancy, smoking history, upper abdominal surgery, EBL, and general anesthesia.

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; EBL, estimated blood loss.

Table S2 Relationship between dyspnea and postoperative complications

Symptom assessment	Patients without postoperative complications, n=335	Patients with postoperative complications, n=70	P-value
mMRC			0.724
<2	278 (83.0)	60 (85.7)
≥2	57 (17.0)	10 (14.3)
CAT			0.885
<10	238 (71.0)	49 (70.0)
≥10	97 (29.0)	21 (30.0)

Note: Data are presented as numbers (%).

Abbreviations: mMRC, modified medical research scale; CAT, COPD assessment test.