Can I Have Surgery if I Have COPD?

Why do I need to see a lung doctor before I can schedule my surgery?

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Many patients with COPD have other conditions that occasionally require a surgical procedure.  When surgeons and anesthesiologists evaluate patients prior to surgery, one of the things they look for is existing of conditions that may make the surgery complicated. This is important because many surgeries require that patients have general anesthesia, which involves being placed temporarily on a mechanical ventilator (also called a breathing machine) during the surgery.

Patients who have COPD are at higher risk of having respiratory complications during surgery or having difficulties getting off the breathing machine once the surgery is over.  This is why it’s important for surgeons and anesthesiologists to know if you are a patient who has COPD before being scheduled for surgery. 

If you are a patient with COPD and are in need of surgery that requires general anesthesia, it is very likely that a lung specialist (a pulmonologist) will be asked to provide guidance about the potential risks of surgery, how to minimize these risks, and at what point it becomes too unsafe to attempt a non-emergent surgery.  You may be asked to see a pulmonary (lung) doctor as an outpatient, or if you are in the hospital, the surgical team may ask for a pulmonary consultation.  This might be frustrating, or even frightening for many patients.  This article is meant to help you understand why a pulmonary consultation is so important prior to having surgery.

COPD Surgery Complications

The main complication that we worry about when patients with COPD need general aesthesia is prolonged respiratory failure. In other words, being unable to get off or stay off the ventilator

The problem is not so much getting put on the breathing machine, but rather, having the strength and supporting lung function to do the hard work of breathing to get off of the machine.

  Having the anesthesiologist pull the tube out is the easy part, but then it is up to the patient’s body (lungs, muscles, and breathing centers in the brain) to breathe slowly, deeply, and with adequate strength so that oxygen can get into the bloodstream and so that other gases (carbon dioxide) can be properly exhaled. 

Patients with severe COPD may have difficulty with this process, and this may result in the development of shortness of breath and buildup of carbon dioxide (which is toxic in high amounts).  In some cases, the breathing machine has to be restarted in order to solve this problem.  A process called ‘weaning’ involves a series of trials that the anesthesiologist will perform prior to pulling the tube out, but even these trials are not perfect in predicting the outcome. 

Breathing tests (pulmonary function tests) are one way to help predict patients’ ability to breath strongly enough to avoid this problem.  Prior to having surgery, your lung doctor will likely obtain tests to learn about how strong your lungs are, and how well they are likely to absorb oxygen during the period immediately after the breathing machine is removed.

Other potential risk factors for having difficulty getting off the ventilator are advanced age, being a smoker, obesity, poor overall health status, and severity of the COPD.   However, even patients who have some of these risk factors may do just fine after surgery.  In general, a good rule of thumb is that patients who are not having frequent pulmonary symptoms and are able to exert themselves without difficulty will generally have fewer problems (if any) with getting off the breathing machine. 

It is important to think about these risks ahead of surgery so that you can talk with your loved ones and doctors about what you would want to do in the event that you had a severe respiratory complication.  Some patients who are unable to get off a breathing machine require a long-term ventilator, via a tracheostomy.  Discussing the “what if’s” with your doctor and loved ones, no matter how unpleasant it may see, is always a good idea, and can give comfort and reassurance to loved ones should they have to step in to make decisions on your behalf.

Another, less serious complication of surgery for patients with COPD is that there is a risk of lung infections.  This is true for any patient who is on a breathing machine, but even more of a possibility for those with pre-existing lung disease, such as COPD.  Research has found that the closer the surgical incision is to the diaphragm in the chest, the more likely the risk of complications.

What Are My Options?

If you have severe COPD, you should talk with your doctor about the risks and benefits of having surgery.  For patients who have a high risk but still need surgery, sometimes anesthesiologists can use anesthesia that does not require the use of a breathing machine, such as an epidural or spinal anesthesia. 

Sometimes, there are less invasive surgical approaches that may be used instead of traditional techniques.  Prior to surgery, you should always make sure to use your inhalers and if you’re a smoker, you should refrain from smoking for six weeks prior to surgery.  This can help reduce your risk of life-threatening pneumonia.  If you are having an acute COPD exacerbation, surgery should be postponed unless it is an absolute emergency.

The Bottom Line 

Talk with a pulmonologist about the risks and benefits of surgery if you have COPD.  It is important to think about the best and worst case scenario in regards to your risks of complications and to talk to your doctor and loved ones about the “what if’s” prior to going to the OR. 

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