Surgery Risks for COPD Patients

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.

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.

Operative Risks

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:

• Bronchospasm: Sudden narrowing of the airways, which can happen with COPD, can prevent oxygen from getting into the lungs.
• Mucus plugs: Mucus often builds up in COPD. A period with diminished coughing and without effortful breathing can make the effects worse during your procedure.
• Pneumothorax (collapsed lung): Lung disease increases the risk of a collapsed lung due to deterioration in lung structure. During surgery, air pressure due to mechanical ventilation can further increase this risk.
• Hypoventilation: Diminished inspiration and expiration can occur while you are not able to move your muscles during anesthesia. This may result in hypoxia (low oxygen in your body's tissues) or hypoxemia (low oxygen in the blood).

Ventilator Dependence

With general anesthesia, a tube is placed into your airway to provide ventilation. Recovering from anesthesia involves a process by which your lungs start to function independently again after relying on a machine for a few hours.

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.

Considerations

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:

• Decreased exercise tolerance, especially with climbing stairs or walking uphill
• History of COPD exacerbations; hospitalization for such events
• Use of non-invasive or mechanical ventilation to help you breathe
• Smoking history: Both current and former smokers are at greater risk.
• Current cough and/or sputum production
• Signs and symptoms of an active lung infection
• Being underweight or overweight
• Other medical illnesses

Preoperative Planning

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:

• Chest X-ray to help identify current lung infections or additional problems within the lungs
• Electrocardiogram (EKG) to help identify heart problems that may increase the risk of surgery
• Spirometry to diagnose and determine the severity of COPD
• Lung diffusion test to evaluate how well oxygen passes from your alveoli to your bloodstream
• Six-minute walk test, a reflection of your exercise tolerance
• Arterial blood gases to help identify preoperative oxygen and carbon dioxide levels in the blood

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:

• Smoking cessation: Because smokers who have COPD have a much greater risk of developing postoperative lung complications from surgery, those who do smoke should quit at least eight weeks prior.
• Drug therapy optimization: Your healthcare provider might recommend that you take at least one dose of a nebulized bronchodilator before your operation. Medical staff can teach you how to use a nebulizer if you do not usually use this type of treatment.
• Treatment for infection and/or exacerbation: Signs and symptoms of active infection may be treated with antibiotics in the period prior to your operation and, in some cases, your healthcare provider may delay your procedure until you have fully recovered.
• Chest physiotherapy: Draining mucus prior to surgery helps remove the excess, which may cause post-operative plugging or pneumonitis. Your healthcare provider may recommend airway clearance techniques or clearing mucus with postural drainage.

Managing the Risks of Surgery

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 as local or regional anesthesia. 

Recovery

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:

• Lung infections such as pneumonia
• Sepsis (a serious whole-body infection)
• Pneumothorax (collapsed lung)
• Respiratory failure
• Slow or impaired wound healing
• Hypoxia, tissue damage and cell death due to inadequate oxygenation to the body, including the brain
• Blood clots and pulmonary emboli: These may occur, especially if the surgery requires that you be inactive for a prolonged period of time.
• Cardiac arrest

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 include breathing exercises with incentive spirometry—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.

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.