Impact of Prior Metabolic Surgery on Outcomes After Hospitalization for Acute COPD Exacerbation: A Nationwide Analysis

Division

West Florida

Hospital

Doctors Hospital of Sarasota

Document Type

Manuscript

Publication Date

8-7-2026

Keywords

COPD, Hypercapnic respiratory failure, Mechanical ventilation, Metabolic surgery, Obesity

Disciplines

Internal Medicine | Medicine and Health Sciences | Nutritional and Metabolic Diseases | Respiratory Tract Diseases

Abstract

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.

Publisher or Conference

Surgery for Obesity and Related Diseases

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