Chest
Volume 153, Issue 3, March 2018, Pages 611-617
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Original Research: COPD
Reduced Risk of Acute Exacerbation of COPD After Bariatric Surgery: A Self-Controlled Case Series Study

https://doi.org/10.1016/j.chest.2017.07.003Get rights and content

Background

Obesity is common among individuals with COPD and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD-related outcomes in patients who are obese.

Methods

Using the population-based ED and inpatient sample in three US states (California, Florida, and Nebraska), we performed a self-controlled case series study of 481 adults who were obese (40-65 years of age) with COPD who underwent bariatric surgery. The primary outcome was an ED visit or hospitalization for acute exacerbation of COPD (AECOPD) from 2005 through 2011. We compared each patient’s risk of the outcome during sequential 12-month periods using presurgery months 13 through 24 as the reference period.

Results

During the 13 to 24 months before bariatric surgery (ie, reference period), 28% (95% CI, 24%-32%) of patients had an ED visit or hospitalization for AECOPD. In the subsequent 12-month presurgery period, the risk did not change materially (31%; 95% CI, 27%-35%), with an adjusted OR (aOR) of 1.16 (95% CI, 0.88-1.53; P = .29). By contrast, during the first 12 months after bariatric surgery, the risk declined significantly (12%; 95% CI, 9%-15%; aOR, 0.35; 95% CI, 0.25-0.49; P < .001). Likewise, in the subsequent period of 13 to 24 months after bariatric surgery, the risk remained significantly low (13%; 95% CI, 11%-17%; aOR, 0.39; 95% CI, 0.28-0.55; P < .001).

Conclusions

The risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery in patients who are obese. This observation suggests the effectiveness of substantial weight reduction on COPD morbidity.

Section snippets

Design and Setting

This is a self-controlled case series study using data from the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) of three geographically dispersed US states (California, Florida, and Nebraska) from January 1, 2005, through December 31, 2011. Details of the methods may be found in e-Appendix 1 and e-Tables 1-6. Additional details of the SEDD and SID can be found elsewhere.10 This study design relies on within-person

Results

We identified 503 patients who were obese with COPD who underwent bariatric surgery from three states (California, Florida, and Nebraska) between January 1, 2007, and December 31, 2009. Of these, we excluded 11 patients with multiple bariatric surgeries and five patients with in-hospital death during their postsurgery period, leaving 481 patients eligible for the analysis. Patient characteristics are summarized in Table 1. Overall, the median age was 53 years, and most patients were women and

Discussion

In this self-controlled case series study using population-based datasets from three US states, we found that, among patients who are obese with COPD, the risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery, and remained significantly lower for at least 2 years. In particular, the decreased risk was prominent for the hospitalization outcome. The temporal pattern of the risk was robust in several sensitivity analyses with different statistical

Conclusions

In this self-controlled case series study of adults who are obese with COPD, we found that bariatric surgery—used as an instrument for investigating the effect of weight reduction—is associated with a significantly lower risk of ED visits or hospitalizations for AECOPD. This risk reduction was sustained for at least 2 years after surgery and persisted across different analytic assumptions. Our inferences lend a significant support to the beneficial role of weight reduction on COPD disease

Acknowledgments

Author contributions: T. G. takes responsibility for the paper as a whole. T. G., Y. T., C. A. C., and K. H. conceived the study. C. A. C. obtained research funding. K. H. supervised the conduct of the study. Y. T. and K. H. provided statistical advice. T. G. and M. K. F. analyzed the data. T. G. drafted the manuscript, and all authors contributed substantially to its revision.

Financial/nonfinancial disclosures: None declared.

Role of sponsors: The sponsor had no role in the design of the study,

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    FUNDING/SUPPORT: This study was supported by the Agency for Healthcare Research and Quality (Rockville, MD) [grant R01 HS-023305 to C. A. C.]; by the Uehara Kinen Memorial Foundation (Tokyo, Japan) [to T. G.]; and by the Abe Fellowship Program (the Social Science Research Council and the Japan Foundation Centre for Global Partnership) [to Y. T.].

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