Chest
Original Research: COPDReduced Risk of Acute Exacerbation of COPD After Bariatric Surgery: A Self-Controlled Case Series Study
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,
References (34)
- et al.
Obesity is associated with increased morbidity in moderate to severe COPD
Chest
(2017) - et al.
Bariatric surgery and emergency department visits and hospitalizations for heart failure exacerbation: population-based, self-controlled series
J Am Coll Cardiol
(2016) - et al.
Positive predictive value of ICD-9-CM codes to detect acute exacerbation of COPD in the emergency department
Jt Comm J Qual Patient Saf
(2008) - et al.
The validity of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for identifying patients hospitalized for COPD exacerbations
Chest
(2012) Pulmonary complications of obesity
Am J Med Sci
(2001)- et al.
Prospective evaluation of the relationship between acute exacerbations of COPD and gastroesophageal reflux disease diagnosed by questionnaire
Respir Med
(2011) - et al.
Centers for Disease Control and Prevention. Employment and activity limitations among adults with chronic obstructive pulmonary disease–United States, 2013
MMWR Morb Mortal Wkly Rep
(2015) - et al.
Prevalence of childhood and adult obesity in the United States, 2011-2012
JAMA
(2014) - et al.
Targeting obesity in COPD through allied health therapies
Respirology
(2016) - et al.
Should we treat obesity in COPD? The effects of diet and resistance exercise training
Respirology
(2016)
The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012
JAMA Surg
Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery
Obesity (Silver Spring)
Risk of an asthma exacerbation after bariatric surgery in adults
J Allergy Clin Immunol
Racial disparities in mortality in patients undergoing bariatric surgery in the U.S.A
Obes Surg
The Asthma-COPD overlap syndrome
N Engl J Med
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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.].