Peri-Operative Surgical Risk and Postoperative Outcomes in Patients With COPD Undergoing Abdominal Surgery: A...

Background  Chronic obstructive pulmonary disease (COPD) is a major global health burden and a leading cause of death and disability, commonly encountered in surgical populations where it independently predicts adverse outcomes. Increased postoperative mortality and morbidity arise from pathophysiological changes such as lung hyperinflation, intrinsic positive end-expiratory pressure (PEEP), impaired gas exchange, and reduced lung volumes after major abdominal surgery. The interaction between disease severity, surgical factors, and anesthesia duration underscores the need for structured peri- and postoperative risk assessment to reduce complications in this vulnerable group. Methods  This retrospective observational study, conducted over 23 months at Faridpur Medical College Hospital, reviewed the records of 107 consecutive patients aged 40 years and old with spirometrically confirmed COPD who underwent elective abdominal surgery under general anesthesia. Strict inclusion and exclusion criteria were applied to ensure diagnostic accuracy and minimize bias, focusing on patients with post-bronchodilator first second of forced expiration (FEV₁) to the full, forced vital capacity (FVC) (FEV₁/FVC) <0.7 and American Society of Anesthesiologists (ASA) class up to IV while excluding emergency, trauma, transplant, and incomplete cases. Comprehensive peri-operative data, including demographic characteristics, pulmonary function indices, laboratory parameters, intra-operative variables, and postoperative complications and outcomes, were systematically extracted to evaluate surgical risk in this vulnerable population. Results The cohort was elderly (70.06±8.49 years), predominantly men (81, 75.7%), with high smoking exposure (70, 65.4%) and hypertension (68, 63.5%), alongside diabetes (25, 23.4%) and heart disease (31, 28.9%); mean BMI was 28.14±3.4 kg/m² with preserved albumin 4.1±0.7 g/dL and creatinine 0.8±0.3 mg/dL. Most patients had a higher anesthetic risk, with 48 (44.9%) in ASA III and 20 (18.7%) in ASA IV, while spirometry showed preserved FEV₁ (92.4±14.4%) and FVC (103.7±14.2%) but reduced FEV₁/FVC (60.9±6.3%), confirming obstruction. Cholecystectomy (26, 24.3%) and appendectomy (22, 20.6%) predominated, with a mean operation time of 190.5±47.6 minutes and anesthesia time of 220.7±31.9 minutes. Postoperative pulmonary complications were notable, particularly atelectasis (10, 9.3%), pneumonia (9, 8.4%), refractory hypoxia (9, 8.4%), and prolonged ventilation (8, 7.5%), while arrhythmia (17, 15.9%) was the most frequent cardiac event. ICU stay was 8.7±3.2 days and hospital stay 18.2±5.3 days, with overall morbidity (16, 14.9%) and mortality (2, 1.9%). Conclusion Patients with COPD undergoing abdominal surgery represent a high-risk population characterized by advanced age, multiple comorbidities, and significant peri-operative vulnerability, where preserved spirometry does not eliminate the risk of pulmonary and cardiac complications. The relatively low mortality observed suggests that structured pre-operative evaluation, optimized intra-operative care, and vigilant postoperative monitoring can effectively reduce adverse outcomes in this complex group.