Utility of chronic obstructive pulmonary disease assessment test in perioperative assessment of patients with mild to moderate chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a well-known risk factor for postoperative pulmonary complications (PPCs), necessitating careful preoperative evaluation in patients undergoing lung resection surgery. The risk of PPCs in patients with COPD may vary with severity of symptoms, and the COPD Assessment Test (CAT) score is commonly used to assess patient quality of life and predict acute exacerbations. However, few studies have explored the correlation between CAT score and PPC incidence in COPD. This study aimed to assess the predictive value of CAT scores for PPCs and compare them with other established PPC predictors in mild to moderate COPD.

Methods: We retrospectively reviewed 83 patients with COPD who underwent preoperative evaluation before lung cancer surgery, including cardiopulmonary exercise tests (CPETs), between January 2020 and June 2022. We compared the predictive value of the following factors for the incidence of PPCs: spirometry, CPETs, 6-min walk tests, symptom-based scores (including CAT scores), the COPD composite severity index, surgery type, comorbidity index, and PPC prediction models.

Results: Among the 83 patients, 16 (19.2%) developed PPCs, with persistent air leakage being the most common complication. CAT scores significantly differed between PPC and non-PPC groups (mean value 9.4 vs. 6.7, P=0.002). In multivariable logistic regression analysis, a CAT score of ≥7 was an independent risk factor for the incidence of PPCs (odds ratio =9.88; 95% confidence interval: 1.95-50.04; P=0.005), whereas other factors demonstrated no significant predictive value.

Conclusions: CAT scores are valuable for evaluating patients with mild to moderate COPD before lung resection surgery, reliably predicting PPCs.