Evidence map›Paper›PMID 40750463›Full record

ArticleBritish journal of anaesthesia2025

Predictive validity of chronic obstructive pulmonary disease phenotypes in inpatient elective surgery: a population-based study.

Ashwin Sankar, Julian F Daza, Joseph S Munn, Daniel I McIsaac, Duminda N Wijeysundera, Peter C Austin, Andrea S Gershon

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Article in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Ashwin SankarDepartment of Anesthesia, St. Michael's Hospital - Unity Health Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: ashwin.sankar@mail.utoronto.ca.
Julian F DazaDepartment of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Joseph S MunnICES, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Daniel I McIsaacICES, Toronto, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
Duminda N WijeysunderaDepartment of Anesthesia, St. Michael's Hospital - Unity Health Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Peter C AustinICES, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Andrea S GershonICES, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionChronic obstructive pulmonary disease (COPD) is prevalent among surgical patients, yet guidance for its preoperative assessment remains limited. Whether previously defined COPD phenotypes influence outcomes after surgery is unknown.

methodsPopulation-based retrospective cohort of older adults (≥65 yr) with COPD who underwent inpatient elective surgery in Ontario, Canada. Candidate COPD phenotypes included: advanced COPD with home oxygen; COPD with frailty; COPD with frequent exacerbation; COPD with cardiovascular comorbidity; both asthma and COPD; and COPD alone. Nested Cox proportional hazards models examined the added performance of COPD phenotype when added to a baseline model (age, sex, procedural risk, Surgical Outcome Risk Tool) in predicting survival in the year after surgery using model fit, discrimination, calibration, and net benefit analyses.

resultsA total of 116 757 patients with COPD underwent inpatient elective surgery; the most common phenotypes included: COPD alone (41.8%), COPD with cardiovascular comorbidity (31.6%), and COPD with frailty (21.8%). There were significant differences in survival between phenotypes when added to the baseline model: advanced COPD (adjusted hazard ratio [aHR] 5.59) and COPD with frailty (aHR 3.56) were associated with markedly decreased survival, while COPD with frequent exacerbation (aHR 1.45) and COPD with cardiovascular comorbidity (aHR 1.35) were associated with moderately decreased survival vs COPD alone. Addition of COPD phenotype improved model fit (likelihood ratio test P<0.001), discrimination (C-index 0.775 vs 0.720), calibration (integrated calibration index 0.035 vs 0.043), and net benefit across all decision thresholds.

conclusionCOPD phenotypes are predictive of postoperative survival and improve perioperative risk stratification. These findings support phenotype-based assessment in the preoperative evaluation of patients with COPD.

Indexed as

Elective Surgical ProceduresPulmonary Disease, Chronic ObstructiveAgedAged, 80 and overCohort StudiesComorbidityFemaleHumansInpatientsMaleOntarioPhenotypeRetrospective StudiesRisk Assessmentchronic obstructive pulmonary diseaseclinical epidemiologyperioperative medicinepredictive validitypreoperative assessmentrespiratory medicinerisk stratification

Identifiers

PMID40750463
PMCPMC12597364

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.