Reduced Risk of Acute Exacerbation of COPD After Bariatric Surgery: A Self-Controlled Case Series Study

Abstract

Obesity is common among individuals with COPD and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD-related outcomes in patients who are obese. Using the population-based ED and inpatient sample in three US states (California, Florida, and Nebraska), we performed a self-controlled case series study of 481 adults who were obese (40-65 years of age) with COPD who underwent bariatric surgery. The primary outcome was an ED visit or hospitalization for acute exacerbation of COPD (AECOPD) from 2005 through 2011. We compared each patient's risk of the outcome during sequential 12-month periods using presurgery months 13 through 24 as the reference period. During the 13 to 24months before bariatric surgery (ie, reference period), 28%(95%CI, 24%-32%) of patients had an ED visit or hospitalization for AECOPD. In the subsequent 12-month presurgery period, the risk did not change materially (31%; 95%CI, 27%-35%), with an adjusted OR (aOR) of 1.16 (95%CI, 0.88-1.53; P= .29). By contrast, during the first 12months after bariatric surgery, the risk declined significantly (12%; 95%CI, 9%-15%; aOR, 0.35; 95%CI, 0.25-0.49; P< .001). Likewise, in the subsequent period of 13 to 24months after bariatric surgery, the risk remained significantly low (13%; 95%CI, 11%-17%; aOR, 0.39; 95%CI, 0.28-0.55; P< .001). The risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery in patients who are obese. This observation suggests the effectiveness of substantial weight reduction on COPD morbidity.