Impact of prior metabolic surgery on outcomes after hospitalization for acute COPD exacerbation: a nationwide analysis.

BACKGROUND

Obesity commonly coexists with chronic obstructive pulmonary disease (COPD) and exacerbates disease severity through impaired respiratory mechanics and systemic inflammation. Metabolic surgery has shown durable metabolic and pulmonary benefits, yet its impact on inpatient outcomes during acute COPD exacerbation admission remains unclear.

OBJECTIVES

To evaluate the association between prior metabolic surgery and inpatient outcomes among adults hospitalized for acute exacerbation of COPD (AECOPD).

SETTING

Community-based, university-Affiliated; United States.

METHODS

Patients with prior metabolic surgery were compared with patients with obesity but no metabolic surgery. Survey weighted logistic and linear regression models adjusted with entropy balancing were used to examine associations between prior metabolic surgery and outcomes including inhospital mortality, hypercapnic respiratory failure (HRF), acute respiratory distress syndrome (ARDS), need for prolonged mechanical ventilation, nonhome discharge, length of stay (LOS), and hospitalization costs.

RESULTS

Of 1,405,560 weighted AECOPD hospitalizations, 53,835 (3.8%) had a history of prior metabolic surgery. Compared with others, patients who had prior metabolic surgery were more often female and had lower co-morbidity burden. After adjustment, prior metabolic surgery was associated with reduced odds of inhospital mortality, HRF, and need for prolonged mechanical ventilation without significant difference in ARDS. Prior metabolic surgery was also linked to shorter LOS and lower hospitalization costs.

CONCLUSIONS

Among the patients hospitalized for AECOPD, prior metabolic surgery was associated with improved survival, fewer respiratory complications, and lower resource utilization. These findings underscore the systemic benefits of metabolic surgery in patients with obesity and COPD.