Inflammatory bowel disease (IBD) can have significant colonic involvement and carries a long-term risk of surgical resection. Chronic obstructive pulmonary disease (COPD) and IBD share multiple inflammatory pathways, suggesting a bidirectional relationship through proposed pulmonary-intestinal cross-talk. This study aimed to examine the association between COPD and 30-day outcomes following non-emergent colectomies for IBD.

Patients with IBD as the primary indication for colectomy were selected from National Surgical Quality Improvement Program (NSQIP) colectomy database 2012–2022. Emergency colectomy cases were excluded. A 1:3 propensity-score matching was used to balance the preoperative characteristics of COPD and non-COPD patients. Thirty-day postoperative outcomes were compared.

Among 25,285 patients who underwent colectomy for IBD, 365 (1.44 %) had COPD. Patients with COPD were older and had more comorbidities. After propensity-score matching, all COPD patients were matched to 1,095 patients without COPD. COPD and non-COPD patients had comparable 30-day mortality (3.29 % vs 2.19 %, p = 0.25). However, COPD patients had higher pulmonary complications (14.79 % vs 7.21 %, p < 0.01) attributed to pneumonia (10.14 % vs 4.02 %, p < 0.01), sepsis (12.88 % vs 8.68 %, p = 0.02), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (28.22 % vs 22.10 %, p = 0.02), discharge not to home (40.28 % vs 34.02 %, p = 0.04), and longer length of stay (p = 0.01).

Therefore, given their mortality rates, colectomy is an effective treatment for IBD patients with concurrent COPD, while their postoperative care should include close monitoring of pulmonary symptoms and timely interventions to prevent further complications. Future research should explore the long-term prognosis of COPD patients after colectomy for IBD.