Risk factors for adverse postoperative outcomes in patients with COPD: an analysis of the eICU-CRD database

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INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is diagnosed in 10–20 % of patients scheduled for non-cardiac surgery. The impact of COPD on clinical outcomes remains a subject of debate, likely due to the disease’s systemic effects on multiple organ systems. Therefore, identifying reliable risk factors for adverse perioperative outcomes in patients with COPD is a pressing clinical challenge. OBJECTIVE: To identify predictors of mortality, ICU and hospital length of stay, as well as the need for mechanical ventilation and hemodynamic support in patients with moderate to severe chronic obstructive pulmonary disease (COPD) undergoing elective non-cardiac surgery. MATERIALS AND METHODS: This retrospective cohort study analyzed data from the eICU Collaborative Research Database database, including adult patients with moderate to severe COPD admitted to the ICU following elective non-cardiac surgery. Multivariate Cox regression and binary logistic regression analyses were performed to identify predictors of outcomes. RESULTS: The study included 1,089 patients (22 % with severe COPD). The overall hospital mortality rate was 7.0 %, while ICU mortality was 3.5 %. The median duration of ICU stay was 1.68 days, and the median hospital stay was 5.9 days. Predictors of hospital and ICU mortality included advanced age, lower BMI, use of vasoactive drugs, need for MV, higher Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scores and several laboratory parameters. The study identified several clinical (low body mass index (BMI), advanced age, higher APACHE IV scores) and laboratory factors (postoperative Neutrophil-to-Lymphocyte Ratio) that were significantly associated with mortality, the need for MV and vasoactive drugs, and extended hospital lengths of stay. CONCLUSIONS: Older age (p < 0.001), low BMI (p = 0.048), and high APACHE IV score (p = 0.048) are independent predictors of hospital mortality in patients with COPD following non-cardiac surgery.

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