A Propensity Score-Matched Analysis of Laparoscopic versus Open Surgery in Patients with COPD

Purpose: This study aims to compare outcomes of laparoscopic surgery to the outcomes of open surgery in patients with chronic obstructive pulmonary disease (COPD). Plethora of studies compares laparoscopic and open surgery in the general population; however, there is a paucity of existing literature examining the optimal surgical techniques in the COPD population. Materials and Methods: A propensity score-matched analysis using the 2012-2015 National Inpatient Sample (NIS) was conducted to match COPD patients undergoing the most common laparoscopic procedures to COPD patients undergoing the same procedures through an open approach. A multivariate logistic regression model was used to assess mortality and complications, and a multivariate linear regression model was used to compare the length of stay and total cost between open and laparoscopic surgery groups in COPD patients. Results: In general, open surgeries in COPD patients had worse outcomes than laparoscopic surgeries. Laparoscopic cholecystectomies were 45% less likely, colectomies were 58% less likely, and diagnostic procedures were 44% less likely to result in mortality than their open counterparts. All surgical cohorts except incisional hernia repairs had higher complication rates with an open approach. Aggregate complication rate reduction among procedures ranged between 29% and 65%. Total costs were higher in all open surgical cohorts except for appendectomies ($3,424-8,455). All open surgeries were associated with a longer length of stay, ranging from an extra day to 3 days, depending on surgery type. Conclusions: Laparoscopic surgery should not be considered a contraindication in patients with COPD. Careful consideration of surgical technique can have significant implications on patient outcomes and hospital costs in the COPD population.