Table of ContentsView AllTable of ContentsOperative RisksConsiderationsPreoperative PlanningManaging the Risks of SurgeryRecovery
Table of ContentsView All
View All
Table of Contents
Operative Risks
Considerations
Preoperative Planning
Managing the Risks of Surgery
Recovery
Chronic obstructive pulmonary disease (COPD)increases the chances of surgical complications, such as infections and respiratory crises. In fact, long-term survival rates for people with severe COPD who have surgery are lower than that of people who do not have COPD. Given this, a pre-operative evaluation that screens for lung disease is done in preparation for any surgical procedure.
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If you have signs of COPD, you will need further pulmonary tests, and your surgical plan may require modifications. Early identification of risks, preoperative optimization, and appropriate anesthesia management can help improve your chances for a good outcome and healthy recovery.
But if your lungs are severely impaired, the cons of surgery may outweigh the pros, and your healthcare providers may recommend that you avoid having the procedure altogether.
With COPD, you could have a pulmonary problem during your procedure. Operative pulmonary issues associated with COPD can cause a respiratory emergency or may be life-threatening.
Your lung and heart function will be closely monitored during your procedure. Most problems can be detected and managed immediately. However, respiratory events during surgery can cause lasting problems if organs become deprived of oxygen before it can be corrected.
Surgical risks when you have COPD include:
Ventilator Dependence
This is more difficult when you have COPD. A significant concern with lung disease is that the additional stress of surgery on the lungs will make you “ventilator-dependent,” even if you were previously breathing OK without assistance.
Before, During, and After General Anesthesia
Identifying risks early in the preoperative period starts with a thorough history and physical examination.
The following COPD-associated factors increase your risk of surgical and post-operative problems and should be considered both when weighing the decision about whether or not to have have surgery and planning the specifics of a procedure:
Typically, before surgery, you will need a pre-operative evaluation. This phase includes screening for health issues that may need to be corrected before surgery (such as a low red blood cell count) or problems that may necessitate postponing surgery (e.g., a major infection).
With COPD, your pre-operative planning includes additional tests that evaluate respiratory function. And there are also a number of things you may need to do to prepare in the days and weeks before your procedure, such as taking medication to decrease mucus or ceasing smoking.
Testing
Before having surgery, your healthcare provider may order any or all of the following tests to evaluate the status of your COPD:
Optimization
Preoperative optimization involves a collaborative effort between you and your healthcare provider to improve your COPD-associated health issues before you have surgery.
This will increase your tolerance for anesthesia and help prevent common post-surgical issues, such as pneumonia.
Steps you may need to take before surgery include:
Your surgeon and anesthesiologist will work together to manage the risks that could occur during surgery.
Adapting Your Procedure
Your healthcare providers may discuss shortening the duration of your surgery and the length of time you are under general anesthesia. This could mean that you would only have a short procedure. For example, if you need a double knee replacement, you may undergo two separate procedures rather than one.
If you are having a cosmetic procedure, your medical team may recommend a less-extensive surgery to avoid prolonged anesthesia and extensive surgical healing.
Type of Anesthesia
Your healthcare providers may discuss the option of avoiding general anesthesia, if possible. Major procedures (like heart surgery or vascular surgery) necessitate general anesthesia, but some procedures (like eye surgery) can be possible with alternatives, such aslocalorregional anesthesia.
Studies have found that people with COPD have a lower risk of pneumonia as well as ventilator dependence if regional anesthesia is used instead of general anesthesia.
Even if you did not have general anesthesia, it takes at least a few days (or weeks with a major surgery) to recover after lying still and having an incision.
COPD can lead to prolonged recovery, and issues can arise days or weeks after surgery. Postoperative complications that are more likely when you have COPD include:
Your medical team will want to make sure that you are having a full recovery before giving you the green light to resume activities. This includes ensuring that you can complete simple tasks without issue, such as walking, eating, and using the toilet.
You may have your breathing, heart rate, oxygen level, and carbon dioxide monitored. Your healthcare providers will check your legs to watch for blood clots, and closely check your wound healing as well.
Your post-operative management may includebreathing exerciseswith incentivespirometry—a procedure in which you breathe into a spirometer, a device that measures your inspiration and expiration so your medical team can monitor your progress.
You may also need care for your wound or suture removal. Your medical team will tell you how to keep it clean and protected as it heals.
How to Care For a Surgical Incision
A Word From Verywell
When you have COPD, it can increase the risk of other health issues, including surgical complications. Because these risks are known, there are tests your medical team can use to assess your respiratory function and steps you and your healthcare providers can take to reduce the risk of complications during and after your surgery.
Once you have recovered after surgery, be sure to maintain close follow up of your pulmonary condition so that you can take medications and adopt lifestyle methods to slow the progression of your COPD.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Traven SA, Horn RW, Reeves RA, Walton ZJ, Woolf SK, Slone HS.The 5-factor modified frailty index predicts complications, hospital admission, and mortality following arthroscopic rotator cuff repair.Arthroscopy. 2019;Jun;101(6):2125-31. doi.10.1016/j.arthro.2019.08.036Park S, Oh EJ, Han S, et al.Intraoperative anesthetic management of patients with chronic obstructive pulmonary disease to decrease the risk of postoperative pulmonary complications after abdominal surgery.J Clin Med. 2020;9(1). Jan 6.doi.10.3390/jcm9010150Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.Ann Intern Med. 2006;144(8):581-95. doi:10.7326/0003-4819-144-8-200604180-00009.Azhar N.Pre-operative optimisation of lung function.Indian J Anaesth.2015;59(9):550-6. doi:10.4103/0019-5049.165858.Duggappa DR, Rao GV, Kannan S.Anaesthesia for patient with chronic obstructive pulmonary disease.Indian J Anaesth. 2015;59(9):574-83. doi:10.4103/0019-5049.165859.Kim HJ, Lee J, Park YS, et al. Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications.Int J Chron Obstruct Pulmon Dis. 2016;11:281-7. doi:10.2147/COPD.S95046.Tapson VF.The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease.Proc Am Thorac Soc. 2005;2(1):71-7. doi: 10.1513/pats.200407-038MS.Additional ReadingCheng Q, Zhang J, Wang H, et al.Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications Among Patients Receiving Bronchoscopic Interventions Under General Anesthesia.PLos One. 2015. 10(7):e0130771. doi:10.1371/journal.pone.0130771Kim H, Lee J, Park Y, et al.Impact of GOLD Groups of Chronic Obstructive Disease on Surgical Complications.International Journal of Chronic Obstructive Pulmonary Disease. 2016. 11:281-7. doi:10.2147/COPD.S95046Kiss G, Claret A, Desbordes J, Porte H.Thoracic Epidural Anesthesia for Awake Thoracic Surgery in Severely Dyspnoeic Patients Excluded From General Anesthesia.Interactive Cardiovascular and Thoracic Surgery. 2014. 19(5):816-23. doi:10.1093/icvts/ivu230Hausman M, Jewell E, Engoren M.Regional Versus General Anesthesia in Surgical Patients With Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications?Anesthesia and Analgesis. 2015. 120(6):1405-12.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Traven SA, Horn RW, Reeves RA, Walton ZJ, Woolf SK, Slone HS.The 5-factor modified frailty index predicts complications, hospital admission, and mortality following arthroscopic rotator cuff repair.Arthroscopy. 2019;Jun;101(6):2125-31. doi.10.1016/j.arthro.2019.08.036Park S, Oh EJ, Han S, et al.Intraoperative anesthetic management of patients with chronic obstructive pulmonary disease to decrease the risk of postoperative pulmonary complications after abdominal surgery.J Clin Med. 2020;9(1). Jan 6.doi.10.3390/jcm9010150Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.Ann Intern Med. 2006;144(8):581-95. doi:10.7326/0003-4819-144-8-200604180-00009.Azhar N.Pre-operative optimisation of lung function.Indian J Anaesth.2015;59(9):550-6. doi:10.4103/0019-5049.165858.Duggappa DR, Rao GV, Kannan S.Anaesthesia for patient with chronic obstructive pulmonary disease.Indian J Anaesth. 2015;59(9):574-83. doi:10.4103/0019-5049.165859.Kim HJ, Lee J, Park YS, et al. Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications.Int J Chron Obstruct Pulmon Dis. 2016;11:281-7. doi:10.2147/COPD.S95046.Tapson VF.The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease.Proc Am Thorac Soc. 2005;2(1):71-7. doi: 10.1513/pats.200407-038MS.Additional ReadingCheng Q, Zhang J, Wang H, et al.Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications Among Patients Receiving Bronchoscopic Interventions Under General Anesthesia.PLos One. 2015. 10(7):e0130771. doi:10.1371/journal.pone.0130771Kim H, Lee J, Park Y, et al.Impact of GOLD Groups of Chronic Obstructive Disease on Surgical Complications.International Journal of Chronic Obstructive Pulmonary Disease. 2016. 11:281-7. doi:10.2147/COPD.S95046Kiss G, Claret A, Desbordes J, Porte H.Thoracic Epidural Anesthesia for Awake Thoracic Surgery in Severely Dyspnoeic Patients Excluded From General Anesthesia.Interactive Cardiovascular and Thoracic Surgery. 2014. 19(5):816-23. doi:10.1093/icvts/ivu230Hausman M, Jewell E, Engoren M.Regional Versus General Anesthesia in Surgical Patients With Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications?Anesthesia and Analgesis. 2015. 120(6):1405-12.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Traven SA, Horn RW, Reeves RA, Walton ZJ, Woolf SK, Slone HS.The 5-factor modified frailty index predicts complications, hospital admission, and mortality following arthroscopic rotator cuff repair.Arthroscopy. 2019;Jun;101(6):2125-31. doi.10.1016/j.arthro.2019.08.036Park S, Oh EJ, Han S, et al.Intraoperative anesthetic management of patients with chronic obstructive pulmonary disease to decrease the risk of postoperative pulmonary complications after abdominal surgery.J Clin Med. 2020;9(1). Jan 6.doi.10.3390/jcm9010150Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.Ann Intern Med. 2006;144(8):581-95. doi:10.7326/0003-4819-144-8-200604180-00009.Azhar N.Pre-operative optimisation of lung function.Indian J Anaesth.2015;59(9):550-6. doi:10.4103/0019-5049.165858.Duggappa DR, Rao GV, Kannan S.Anaesthesia for patient with chronic obstructive pulmonary disease.Indian J Anaesth. 2015;59(9):574-83. doi:10.4103/0019-5049.165859.Kim HJ, Lee J, Park YS, et al. Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications.Int J Chron Obstruct Pulmon Dis. 2016;11:281-7. doi:10.2147/COPD.S95046.Tapson VF.The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease.Proc Am Thorac Soc. 2005;2(1):71-7. doi: 10.1513/pats.200407-038MS.
Traven SA, Horn RW, Reeves RA, Walton ZJ, Woolf SK, Slone HS.The 5-factor modified frailty index predicts complications, hospital admission, and mortality following arthroscopic rotator cuff repair.Arthroscopy. 2019;Jun;101(6):2125-31. doi.10.1016/j.arthro.2019.08.036
Park S, Oh EJ, Han S, et al.Intraoperative anesthetic management of patients with chronic obstructive pulmonary disease to decrease the risk of postoperative pulmonary complications after abdominal surgery.J Clin Med. 2020;9(1). Jan 6.doi.10.3390/jcm9010150
Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.Ann Intern Med. 2006;144(8):581-95. doi:10.7326/0003-4819-144-8-200604180-00009.
Azhar N.Pre-operative optimisation of lung function.Indian J Anaesth.2015;59(9):550-6. doi:10.4103/0019-5049.165858.
Duggappa DR, Rao GV, Kannan S.Anaesthesia for patient with chronic obstructive pulmonary disease.Indian J Anaesth. 2015;59(9):574-83. doi:10.4103/0019-5049.165859.
Kim HJ, Lee J, Park YS, et al. Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications.Int J Chron Obstruct Pulmon Dis. 2016;11:281-7. doi:10.2147/COPD.S95046.
Tapson VF.The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease.Proc Am Thorac Soc. 2005;2(1):71-7. doi: 10.1513/pats.200407-038MS.
Cheng Q, Zhang J, Wang H, et al.Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications Among Patients Receiving Bronchoscopic Interventions Under General Anesthesia.PLos One. 2015. 10(7):e0130771. doi:10.1371/journal.pone.0130771Kim H, Lee J, Park Y, et al.Impact of GOLD Groups of Chronic Obstructive Disease on Surgical Complications.International Journal of Chronic Obstructive Pulmonary Disease. 2016. 11:281-7. doi:10.2147/COPD.S95046Kiss G, Claret A, Desbordes J, Porte H.Thoracic Epidural Anesthesia for Awake Thoracic Surgery in Severely Dyspnoeic Patients Excluded From General Anesthesia.Interactive Cardiovascular and Thoracic Surgery. 2014. 19(5):816-23. doi:10.1093/icvts/ivu230Hausman M, Jewell E, Engoren M.Regional Versus General Anesthesia in Surgical Patients With Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications?Anesthesia and Analgesis. 2015. 120(6):1405-12.
Cheng Q, Zhang J, Wang H, et al.Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications Among Patients Receiving Bronchoscopic Interventions Under General Anesthesia.PLos One. 2015. 10(7):e0130771. doi:10.1371/journal.pone.0130771
Kim H, Lee J, Park Y, et al.Impact of GOLD Groups of Chronic Obstructive Disease on Surgical Complications.International Journal of Chronic Obstructive Pulmonary Disease. 2016. 11:281-7. doi:10.2147/COPD.S95046
Kiss G, Claret A, Desbordes J, Porte H.Thoracic Epidural Anesthesia for Awake Thoracic Surgery in Severely Dyspnoeic Patients Excluded From General Anesthesia.Interactive Cardiovascular and Thoracic Surgery. 2014. 19(5):816-23. doi:10.1093/icvts/ivu230
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