Concealed COPD diagnosis in candidates to thoracic surgery

Introduction: pulmonary function evaluation in candidates to thoracic surgery is required to assess the risk of cardiorespiratory complications and long-term disability, to predict postoperative lung volumes and to eventually maximize respiratory function before surgery. Although the association between COPD and surgical risk is well documented, a large amount of high risk of COPD patients never performed a spirometry assessment before the pre-operative risk evaluation.Aims and objectives: to investigate the prevalence of unrecognized COPD diagnosis in a sample of subjects referred for pre thoracic-surgery respiratory evaluation and verify whether a concealed COPD may interfere with operative risks and survival rates.Methods: comprehensive lung function, dyspnea score, surgical outcomes, length of postoperative hospi­talization, postoperative pulmonary complications (PPCs), and in-hospital mortality were retrospective assessed in 200 patients undergoing pulmonary resection. When newly diagnosed, COPD patients started inhaled treatment before surgery.Results: the median age cohort was 69±9, one hundred and fifty (75%) were male, 169/200 (85%) were former-smokers or current smokers. Out of COPD patients (85/200; 43%), 64% showed a concealed COPD diagnosis. Despite the high rate of undertreated COPD, no increased risk of complication was associated with having a concealed diagnosis of COPD.Conclusions: a high prevalence of concealed COPD was observed. A delay of COPD diagnosis in lung cancer patients’ candidates to thoracic surgery can increase operative risks, delay the procedure or abrupt the surgical process. More awareness on this issue is needed by surgeons, cancer and respiratory specialists.