Postoperative Pulmonary Complication in Patients with Chronic Obstructive Pulmonary Disease Undergoing Bariatric Surgery: An MBSAQIP Analysis

Abstract

INTRODUCTION: Bariatric surgery (BaS) may decrease the risk of developing acute exacerbation in patients with COPD. This population may be at increased risk of respiratory complication. This study aims to analyze the risk of postoperative pulmonary complication (PPC) in patients with obesity and COPD undergoing BaS. METHODS: We performed a retrospective analysis of the MBSAQIP data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) from 2015 to 2019. The primary outcome was any PCC, defined as a composite of postoperative pneumonia, mechanical ventilation >48 hours, and unplanned endotracheal intubation. Univariate and multivariate analyses were performed to look for any differences between patients with and without COPD. A subgroup analysis was performed to examine any differences between patients with COPD with or without home oxygen requirements. RESULTS: A total of 752,722 patients were included. Univariate analysis showed that PPC occurred in 2,390 patients, 0.3% of the patients without COPD vs 1.3% of the patients with history of COPD (p < 0.001). Multivariate analysis showed that, after adjusting for covariates, COPD independently increased the risk of developing a PPC by 1.73 times (odds ratio 1.734, CI 1.407 to 2.138). Subgroup analysis showed that PPCs were significantly higher in the oxygen-dependent group compared with the oxygen independent group (2.4% vs 1.1%, p < 0.001). CONCLUSION: PPCs are significantly higher among patients with obesity and concomitant COPD, especially if there is oxygen dependency. The risk and benefits of undergoing BaS in this population must be carefully addressed