Table 2 Postoperative outcome in chronic obstructive pulmonary disease (COPD) and non-COPD patients with abdominal aortic aneurysms (AAA).

From: Chronic obstructive pulmonary disease effect on the prevalence and postoperative outcome of abdominal aortic aneurysms: A meta-analysis

Study (published year)

Study type

Male (%)

Age

Region

AAA

30-d mortality

Long term mortality

30-d morbidity

Long-term morbidity

Comment

Crawford et al. (1986)

PBS

85.1

28–85

US

101 elective open COPD: 34 Non-COPD: 67

30-d 1 (2.9%) 7 (10.4%) (P = 0.2611)

 

30-d Dialysis 2 (5.9%) 5 (7.5%) (P = 1.000)

  

Katz et al. (1994)

PBS

82

≥50

US

8185 open COPD: 1792 Non-COPD: 6393

In-hospital 142 (7.9%) 473 (7.4%) (P = 0.6)

   

Elective: 8185 Rupture: 1829

Koskas et al. (1997)

PS

89.9

42–92

France

158 elective open COPD: 51 Non-COPD: 107

 

5.3-y (P < 0.01)

   

Eskandari et al. (oxygen)

CCS

76.9

72m

US

65 elective open COPD: 14 Non-COPD: 51

  

In-hospital 4 (28.6%) 18 (35.3%)

 

Oxygen dependent COPD

Cuypers et al. (2000)

PBS

91.8

70m

Netherland

1871 elective EVAR COPD: 683 Non-COPD: 1188

   

1.5-y Conversion 27 (4.0%) 22 (1.9%) OR 2.22 (1.12–4.37)*

 

Axelrod et al. (2001)

PBS

100

69m

US

      

Rupture

    

52 open rupture COPD: 20 Non-COPD: 32

30-d 8 (40.0%) 2 (6.3%)

    

No-rupture

    

1001 elective open COPD: 244 Non-COPD: 757

30-d 9 (3.7%) 28 (3.7%) OR 1.1(P = 0.81)*

 

30-d OR 2.3 (P = 0.07)*In ventilation >96 h

  

Huber et al. (2001)

PBS

79.7

72m

US

16450 elective open

In-hospital OR 1.0; 95%CI 0.9–1.3 (P = 0.67)*

 

In-hospital OR 1.3; 95% CI 1.1–1.4 (P < 0.0001)*

  

Biancari et al. (2002)

PBS

90.4

66m

Finland

208 EVAR COPD: 54 Non-COPD: 154

 

15-y (P = 0.001) RR 1.76, 95% CI 1.22–2.44 (P = 0.002)*

  

Elective: 167; Emergency for no rupture: 9; Emergency for rupture: 32

Piper et al. (2003)

PBS

68.4

72m

US

147 open rupture COPD: 35 Non-COPD: 112

In-hospital 9 (25.7%) 42 (37.5%)

    

Tassiopoulos et al. (2004)

PBS

81.7

71m

US

115 elective open COPD: 22 Non-COPD: 93

  

In-hospital Ventilator time (P = 0.12) ICU stay (P = 0.015) Postoperative ileus (NS) Hospital stay (P = 0.03)

  

Hertzer et al. (2005)

PBS

86

≥47

US

855 elective open COPD: 53 Non-COPD: 802

30-d OR 3.8; 95% CI 1.2–11.6 (P = 0.036) OR 5.1; 95% CI 1.6–16.5 (P = 0.0006)*

15-y HR 1.55; 95% CI 1.11–2.17 (P = 0.016) HR 1.6 95% CI 1.1–2.2 (P = 0.012)*

  

HR: any death (postoperative and late death)

Hua et al. (2005)

PS

81.8

72m

US

1042 elective EVAR and open COPD: 221 Non-COPD: 821

30-d OR 1.67; 95%CI 0.81–3.44 (P = 0.17)

 

30-d OR 1.42; 95CI% 1.03–1.94 (P = 0.03) OR 1.32; 95%CI 0.91–1.91 (P = 0.15)*

 

EVAR: 460 Open: 582

Schouten et al. (2006)

PBS

86

70m

Netherland

500 elective open COPD: 31 Non-COPD: 469

30-d OR 1.83; 95% CI 0.86–3.87 (P = 0.12) OR 1.50; 95% CI 0.63–3.58 (P = 0.36)*

 

30-d OR 1.91; 95% CI 0.93–3.93(P = 0.08) OR 1.81; 0.85–3.89 (P = 0.13)*

  

Zarins et al. (2006)

PS

88.3

74m

US

923 elective EVAR COPD: 90 Non-COPD: 833

 

5-y HR 1.84 (P < 0.0001)*AAA related death HR 1.75 (P = 0.18)*

 

5-y AAA rupture HR 0.987 (P = 0.98)*Conversion HR 1.07 (P = 0.18)*

 

Anain et al. (2007)

PBS

75

57–89

US

40 EVAR and open rupture COPD: 17 Non-COPD: 23

30-d 5 (29.4%) 4 (17.4%)

   

EVAR: 30 Open: 10

Bonardelli et al. (2007)

PBS

93.5

NA

Italy

1111 elective open COPD: 428 Non-COPD: 683

30-d 14 (3.3%) 16 (2.3%) (P = 0.35)

5-y (P < 0.001) (P = 0.014)*

   

Berge et al. (2008)

PBS

82.9

71m

US

1041 EVAR and open COPD: 144 Non-COPD: 897

30-d Open OR 1.2; 95% CI 0.7–2.1 (P = 0.48)*

20-y OR 1.5; 95% CI 1.17–1.92 (P = 0.001)*

  

EVAR: 136 Open rupture: 299; Open no rupture: 606

Botha et al. (2008)

PBS

80.6

76m

Australia

62 open rupture COPD: 17 Non-COPD: 45

In-hospital 8 (47.1%) 12 (26.7%) OR 6.7; 95% CI 1.1–41.3 (P = 0.04)*

    

Park et al. (2008)

CCS

88.6

76m

US

342 elective EVAR COPD: 137 Non-COPD: 205

In-hospital 3 (2.2%) 4 (2.0%) (P = 1.0)

 

In-hospital 18 (40.1%) 18 (43.9%)

 

Long-term mortality: COPD (CHF: 3; MI:1;; RC: 14); Non-COPD (CHF: 2; MI: 2; RC: 14)

Abedi et al. (2009)

PBS

82.3

74m

US

3662 elective EVAR COPD: 700 Non-COPD: 2962

  

30-d OR 1.31 (P < 0.05)*in postoperative transfusion 4u. w/in 72 h of procedure OR 2.28 (P < 0.05)*

  

Antonello et al. (2009)

PBS

79.6

47–91

Italy

103 open rupture COPD: 35 Non-COPD: 68

30-d 15 (42.9%) 15 (22.1%) (P = 0.028)

    

Beck et al. (2009)

PS

71

74m

US

      

Open

    

748 elective open COPD: 269 Non-COPD: 479

 

1-y P = 0.002 HR 3.6; 95% CI 1.9–7.0*

   

EVAR

    

639 elective EVAR COPD: 249 Non-COPD: 390

 

1-y P = 0.007

   

Holst et al. (2009)

PBS

86

76m

Sweden

90 EVAR rupture COPD: 28 Non-COPD: 62

30-d RR 4.3; 95%CI 1.7–11.0 (P = 0.003)*

    

Mastracci et al. (2010)

PS

88

75m

US

412 elective EVAR COPD: 155 Non-COPD: 257

 

6-y 106 (68.4%) 136 (52.9%) HR1.6; 95% CI 1.3–2.1 (P = 0.002) HR 1.6; 95% CI 1.2–2.2 (P = 0.001)*

   

Geisbüsch et al. (2011)

PBS

85

>80

US, Germany

299 elective EVAR COPD: 90 Non-COPD: 209

 

6.8-y HR 1.56; 95% CI 1.03–2.35 (P = 0.032)*

   

Twine et al. (2011)

PBS

92.7

55–88

UK

178 elective EVAR COPD: 33 Non-COPD: 145

 

3-y HR 0.42; 95% CI 0.25–0.72 (P = 0.002)

   

Wisniowski et al. (2011)

PBS

87.3

73m

Australia

197 elective EVAR COPD: 39 Non-COPD: 158

 

3-y (P = 0.027) (P = 0.035)*

   

Gupta et al. (2012)

PBS

72.5

66–78

US

598 elective open COPD: 122 Non-COPD: 476

30-d 11 (9.0%) 16 (3.4%) OR 3.17; 95% CI 1.39–7.25*

 

30-d Major complication: 48 (39.3%) 132 (27.7%) (P = 0.01)

  

Ohrlander et al. (2012)

PS

86

53–89

Sweden

233 elective EVAR COPD: 95 Non-COPD: 138

 

5-y 38 (40.0%) 39 (28.3%) (P = 0.058)

  

Long-term mortality COPD (grade ≥2) (P = 0.040) COPD (grade ≥3) (P = 0.016) PaO2 < 8.0 kPa or COPD, grade ≥3 (P = 0.005) HR 2.06; 95% CI 1.24–3.42 (P = 0.005)*

De Martino et al. (2013)

PBS

79.3

67–82

US

2367 elective EVAR and open

     

Untreated

    

1897 elective EVAR and open COPD: 336 Non-COPD: 1562

 

5-y OR 1; 95% CI 0.7–1.3*

  

EVAR: 1303 Open: 594 Untreated COPD

Medical

    

1936 elective EVAR and open COPD: 374 Non-COPD: 1562

 

5-y OR 1.3; 95% CI 1.0–1.8*

  

EVAR: 1355 Open: 579 Medication COPD

Oxygen

    

1659 elective EVAR and open COPD: 97 Non-COPD: 1562

 

5-y OR 3.0; 95% CI 2.0–4.5*

  

EVAR: 1165 Open: 493 Oxygen dependent COPD

Stone et al. (2013)

PS

78.1

72m

US

      

Medical

    

3320 elective EVAR and open COPD: 1082 Non-COPD: 2238

 

5-y HR 1.22; 95% CI 1–1.5 (P = 0.02)*

  

EVAR: 2043 Open: 1412 Medical COPD

Oxygen

    

2373 elective EVAR and open COPD: 135 Non-COPD: 2238

In-hospital OR 2.02; 95% CI 1.0–4.0 (P = 0.04)*

5-y HR 3.02; 95%C 2.2–4.1 (P < 0.001)*

  

Oxygen dependent COPD

Raux et al. (2014)

CCS

76.6%

73m

US and France

563 elective FEVAR and open

  

30-d OR 3.3; 95%CI 1.7–6.7 (P = 0.0008)*

  
  1. PBS: population based screening; CCS: case control study; PS: prospective study; COPD: chronic obstructive pulmonary disease; EVAR: endovascular aortic repair; OR: odd ratio; RR: relative risk; HR: hazard rate; CI: confidence interval; SDD: same day discharge; POD: postoperative discharge; CHF: congestive heart failure; MI: myocardial infarction; RC: respiratory complications; ICU: intensive care unit; NS: not significant; NA: not available; O2: oxygen; m mean; *adjusted data available.
  2. Reference in supplemental files.