- •Incidence of postoperative pneumonia was higher among COPD than non-COPD patients.
- •In-hospital mortality (IHM) was lower among COPD patients than non-COPD patients.
- •IHM decreased over time, regardless of the existence or not of COPD
- •Higher mortality rates were associated with increasing age and comorbidity
To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD.
We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database.
We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68–2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p < 0.05). Factors independently associated with IHM, among COPD and non-COPD patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88–0.95).
The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Internal Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Measuring the global burden of disease.N Engl J Med. 2013; 369: 448-457
- Identification of clinical phenotypes using cluster analyses in COPD patients with multiple comorbidities.Biomed Res Int. 2014; 2014: 420134
- Global and regional estimates of COPD prevalence: systematic review and meta-analysis.J Glob Health. 2015; 5020415
- Postoperative lung complications and mortality in patients with mild-to-moderate COPD undergoing elective general surgery.Arch Bronconeumol. 2001; 37: 227-234
- Airflow limitation severity and post-operative pulmonary complications following extra-pulmonary surgery in COPD patients.Respirology. 2017; 22: 935-941
- Preoperative evaluation: estimation of pulmonary risk.Anesthesiol Clin. 2016; 34: 71-88
- Excess costs attributable to postoperative complications.Med Care Res Rev. 2011; 68: 490-503
- Predicting postoperative pulmonary complications: implications for outcomes and costs.Curr Opin Anaesthesiol. 2014; 27: 201-209
- Pulmonary complications after major abdominal surgery: National surgical quality improvement program analysis.J Surg Res. 2015; 198: 441-449
- The epidemiology and risk factors for postoperative pneumonia.J Clin Med Res. 2017; 9: 466-475
- Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study.BMJ Open. 2017 Jan 13; 7e013029
- Rib fractures: relationship with pneumonia and mortality.Crit Care Med. 2006 Jun; 34: 1642-1646
- Preoperative pulmonary evaluation.N Engl J Med. 1999; 340: 937-944
- Postoperative pulmonary complications.Med Clin N Am. 2001; 85: 1129-1139
- Participants in the National Veterans Affairs Surgical Quality Improvement Program. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery.Ann Intern Med. 2001; 135: 847-857
- Risk factors for nosocomial pneumonia in patients with abdominal surgery.Cir Cir. 2016; 84: 21-27
- Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD.Int J Chron Obstruct Pulmon Dis. 2016; 11: 1317-1326
- Lung resection in patients with preoperative FEV1 <35% predicted.Chest. 2005; 127: 1984-1990
- Impact of COPD on postoperative outcomes: results from a national database.Chest. 2013; 143: 1599-1606
- Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends.Ann Thorac Surg. 2006; 81: 1830-1837
- Postoperative complications after coronary artery bypass grafting in patients with chronic obstructive pulmonary disease.Medicine (Baltimore). 2016; 95e2926
- Conjunto mínimo básico de datos, hospitales del INSALUD.http://www.ingesa.msssi.gob.es/estadEstudios/documPublica/CMBD-2001.htmDate accessed: January 16, 2017
- Global Initiative for Chronic Obstructive Lung Disease (GOLD).(Available at)http://goldcopd.orgDate: 2017
- Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study.Lancet. 2005; 366: 1875-1881
- Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.Thorax. 2009; 64 (863-8.24)
- Codificación en CIE-9-MC. Enfermedades del aparato respiratorio.(Available at)https://www.repositoriosalud.es/bitstream/10668/312/3/8-EnfermedadesDelAparatoRespiratorio.pdfDate accessed: January 25, 2018
- Accuracy of ICD 9 CM codes in detecting CAP for incidence and vaccine efficacy studies.Am J Epidemiol. 1999; 149: 282-289
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Derivation and validation of a clinical prediction rule for nosocomial pneumonia after coronary artery bypass graft surgery.Clin Infect Dis. 2010; 50: 493-501
- Pulmonary complications after abdominal surgery in patients with mild-to-moderate chronic obstructive pulmonary disease.Int J Chron Obstruct Pulmon Dis. 2016; 11: 2785-2796
- Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival.Respir Med. 2015; 109: 1340-1346
- Risk factors of postoperative nosocomial pneumonia in stage I-IIIa lung cancer patients.Asian Pac J Cancer Prev. 2014; 15: 3071-3074
- Systemic manifestations and comorbidities of COPD.Eur Respir J. 2009; 33: 1165-1185
- Comorbidities of chronic obstructive pulmonary disease.Curr Opin Pulm Med. 2011; 17: S21-8
- Complications after total knee replacement in patients with chronic obstructive pulmonary disease: a nationwide case-control study.Medicine (Baltimore). 2016; 95e4835
- Perioperative medical management of patients with COPD.Int J Chron Obstruct Pulmon Dis. 2007; 2: 493-515
- Risk factors for fatal outcome in surgical patients with postoperative aspiration pneumonia.Int J Surg. 2016; 27: 21-25
- Less Is More: Results of a Statewide Analysis of the Impact of Blood Transfusion on Coronary Artery Bypass Grafting Outcomes.Ann Thorac Surg. 2017 Oct 24; 4975 (30962-1. pii: S0003)
- A comprehensive analysis of the causes and predictors of 30-day mortality following hip fracture surgery.Clin Orthop Surg. 2017; 9: 10-18
- Postoperative pulmonary complications after liver transplantation: assessment of risk factors for mortality.Transplant Proc. 2015; 47: 1488-1494
- Morbidity- and mortality-related prognostic factors of nontraumatic splenectomies.Asian J Surg. 2014; 37: 73-79
- Risk of major nonemergent inpatient general surgical procedures in patients on long-term dialysis.JAMA Surg. 2013; 148: 137-143
- The incidence of postoperative pneumonia in various surgical subspecialties: a dual database analysis.Surg Technol Int. 2017; 30: 45-51
Published online: February 13, 2018
Accepted: February 10, 2018
Received in revised form: January 29, 2018
Received: November 17, 2017
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.