Does a Presurgical Targeted Screening Program for Airflow Obstruction Result in Significant Clinical Interventions?

SESSION TITLE: COPD Poster Discussion SESSION TYPE: Original Investigation Poster Discussion PRESENTED ON: Sunday, October 25, 2015 at 01:30 PM - 03:00 PM PURPOSE: Chronic obstructive lung disease (COPD) is a highly prevalent disease that often goes undiagnosed. Patients with COPD are at higher risk for post-operative complications such as exacerbations thus increasing length of stay and cost to the healthcare system. A targeted spirometry screening program was implemented within a pre-surgical screening (PSS) clinic to detect undiagnosed or uncontrolled airways disease and identify patients in need of treatment optimization. This quality assurance study examines the clinical interventions which arose from this targeted spirometry screening program. METHODS: A targeted spirometry screening program for airflow obstruction was implemented within the PSS clinic of the Jewish General Hospital (JGH), Montreal, Canada. Current or ex-smokers with respiratory symptoms and those with a history of COPD or asthma underwent pre-bronchodilator spirometry. This study includes the patients who were seen for a pre-surgical pulmonary consultation at the JGH following an abnormal screening spirometry result. Charts were reviewed to extract patient characteristics, airways disease history, smoking status, test results and clinical interventions. RESULTS: Of the 516 patients referred for targeted screening spirometry, 212 (41%) patients had abnormal results. The PSS clinic referred 118 patients for a pulmonary consultation of whom 101 were seen pre-operatively at the JGH. Consultation notes were unavailable in 3 cases thus 98 patients form the study sample. Forty-eight patients did not have a prior diagnosis of COPD or asthma and 46 were smokers at time of screening. Sixty patients had at least moderate airflow obstruction. Pulmonary consultations led to at least one clinical intervention in 65 patients. Two surgeries were cancelled and 3 others were delayed. Medication adjustments were made in 55 patients. The use of CPAP peri-operatively was recommended for one patient. One patient was sent for a sleep study and 3 patients primarily received education. CONCLUSIONS: A targeted spirometry screening program within a PSS clinic detected a significant number of patients with airway obstruction and in need of treatment optimization. Pre-operative pulmonary consultations led to clinical interventions for an important number of patients. CLINICAL IMPLICATIONS: Through a simple pre-surgical targeted screening program, an important number of pre-operative interventions were performed to optimize patient health prior to surgery, potentially reducing post-operative complications and length of stay. DISCLOSURE: Chantal Robitaille: Employee: Boehringer Ingelheim The following authors have nothing to disclose: Esther Dajczman, Andrew Hirsch, David Small, Pierre Ernst, Dana Porubska, Mark Palayew No Product/Research Disclosure Information