OBJECTIVES: Obesity has been thought to predispose patients to excess morbidity after lung resection because of decreased diaphragm excursion, reduced lung volumes and relative immobility. We assessed the relationship of body mass index (BMI) to acute outcomes after major lung resection. METHODS: Information from our database of lung resections was evaluated for the period 1980-2011. Univariate analysis for adverse events (pulmonary, cardiovascular, other and overall) was used to select variables for inclusion in multivariate logistic regression analyses. Missing values were imputed. BMI was categorized as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and very obese (≥ 35). RESULTS: Among 1369 patients, there were 703 males (51%) and the mean age was 62 ± 11 years. Complications included the following: pulmonary 12%, cardiovascular 15%, other 16%, mortality 5% and any 29%. The incidence of complications decreased during each decade of study (40, 30, 26, 20%; P < 0.0001) and the incidence of obese/very obese increased during the same intervals (11, 22, 30, 25%; P = 0.0007). Adjusting for age, performance status, coronary artery disease, smoking status, diffusing capacity of the lung for carbon monoxide, forced expiratory volume in 1 s and operation year, being overweight/obese/very obese did not increase the risk of postoperative complications in any category. In fact, patients in this group showed a lower rate of cardiovascular complications than those with BMI ≤ 25 (odds ratio (OR): 0.72; 95% confidence interval (CI): 0.51-1.00; P = 0.048). However, being underweight was importantly associated with an increased risk of pulmonary complications (OR: 2.5; 95% CI: 1.3-4.9; P = 0.0087) and of operative mortality (OR: 2.96; 95% CI: 1.28-6.86; P = 0.011). CONCLUSION: Being overweight or obese does not increase the risk of complications after major lung resection. In contrast, patients who are underweight are at significantly increased risk of pulmonary complications and mortality. Knowledge of the relationship of BMI to perioperative risk for major lung resection is essential in proper risk stratification.
OBJECTIVES: Obesity has been thought to predispose patients to excess morbidity after lung resection because of decreased diaphragm excursion, reduced lung volumes and relative immobility. We assessed the relationship of body mass index (BMI) to acute outcomes after major lung resection. METHODS: Information from our database of lung resections was evaluated for the period 1980-2011. Univariate analysis for adverse events (pulmonary, cardiovascular, other and overall) was used to select variables for inclusion in multivariate logistic regression analyses. Missing values were imputed. BMI was categorized as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and very obese (≥ 35). RESULTS: Among 1369 patients, there were 703 males (51%) and the mean age was 62 ± 11 years. Complications included the following: pulmonary 12%, cardiovascular 15%, other 16%, mortality 5% and any 29%. The incidence of complications decreased during each decade of study (40, 30, 26, 20%; P < 0.0001) and the incidence of obese/very obese increased during the same intervals (11, 22, 30, 25%; P = 0.0007). Adjusting for age, performance status, coronary artery disease, smoking status, diffusing capacity of the lung for carbon monoxide, forced expiratory volume in 1 s and operation year, being overweight/obese/very obese did not increase the risk of postoperative complications in any category. In fact, patients in this group showed a lower rate of cardiovascular complications than those with BMI ≤ 25 (odds ratio (OR): 0.72; 95% confidence interval (CI): 0.51-1.00; P = 0.048). However, being underweight was importantly associated with an increased risk of pulmonary complications (OR: 2.5; 95% CI: 1.3-4.9; P = 0.0087) and of operative mortality (OR: 2.96; 95% CI: 1.28-6.86; P = 0.011). CONCLUSION: Being overweight or obese does not increase the risk of complications after major lung resection. In contrast, patients who are underweight are at significantly increased risk of pulmonary complications and mortality. Knowledge of the relationship of BMI to perioperative risk for major lung resection is essential in proper risk stratification.
Entities:
Keywords:
Body mass index; Lung resection; Obesity; Outcomes
Authors: Vickie E Baracos; Tony Reiman; Marina Mourtzakis; Ioannis Gioulbasanis; Sami Antoun Journal: Am J Clin Nutr Date: 2010-02-17 Impact factor: 7.045
Authors: Patrick Bagan; Pascal Berna; Florence De Dominicis; Joao Carlos Das Neves Pereira; Pierre Mordant; Bertrand De La Tour; Francoise Le Pimpec-Barthes; Marc Riquet Journal: Ann Thorac Surg Date: 2012-07-26 Impact factor: 4.330
Authors: Jamii B St Julien; Melinda C Aldrich; Shubin Sheng; Stephen A Deppen; William R Burfeind; Joe B Putnam; Eric S Lambright; Jonathan C Nesbitt; Eric L Grogan Journal: Ann Thorac Surg Date: 2012-10-04 Impact factor: 4.330
Authors: Carla M M Prado; Jessica R Lieffers; Linda J McCargar; Tony Reiman; Michael B Sawyer; Lisa Martin; Vickie E Baracos Journal: Lancet Oncol Date: 2008-06-06 Impact factor: 41.316
Authors: Philip W Smith; Hongkun Wang; Leo M Gazoni; K Robert Shen; Thomas M Daniel; David R Jones Journal: Ann Thorac Surg Date: 2007-10 Impact factor: 4.330
Authors: Daniel J Boffa; Mark S Allen; Joshua D Grab; Henning A Gaissert; David H Harpole; Cameron D Wright Journal: J Thorac Cardiovasc Surg Date: 2007-12-21 Impact factor: 5.209
Authors: Jelmer E Oor; Johannes M A Daniels; Yvette J Debets-Ossenkopp; Elly S M de Lange-de Klerk; Jan W A Oosterhuis; Chris Dickhoff; Koen J Hartemink Journal: Langenbecks Arch Surg Date: 2016-08-02 Impact factor: 3.445
Authors: Trevor Williams; Brian C Gulack; Sunghee Kim; Felix G Fernandez; Mark K Ferguson Journal: Ann Thorac Surg Date: 2016-07-29 Impact factor: 4.330
Authors: Boris Sepesi; Kathryn A Gold; Arlene M Correa; John V Heymach; Ara A Vaporciyan; Jason Roszik; Ethan Dmitrovsky; Xi Liu Journal: J Thorac Oncol Date: 2017-05-25 Impact factor: 15.609
Authors: Michael J Pienta; Peng Zhang; Brian A Derstine; Binu Enchakalody; William B Weir; Tyler Grenda; Rebecca Goulson; Rishindra M Reddy; Andrew C Chang; Stewart C Wang; Jules Lin Journal: Ann Thorac Surg Date: 2017-12-02 Impact factor: 4.330
Authors: Marco Gallo; Valerio Adinolfi; Viola Barucca; Natalie Prinzi; Valerio Renzelli; Luigi Barrea; Paola Di Giacinto; Rosaria Maddalena Ruggeri; Franz Sesti; Emanuela Arvat; Roberto Baldelli; Emanuela Arvat; Annamaria Colao; Andrea Isidori; Andrea Lenzi; Roberto Baldell; M Albertelli; D Attala; A Bianchi; A Di Sarno; T Feola; G Mazziotti; A Nervo; C Pozza; G Puliani; P Razzore; S Ramponi; S Ricciardi; L Rizza; F Rota; E Sbardella; M C Zatelli Journal: Rev Endocr Metab Disord Date: 2020-10-06 Impact factor: 6.514
Authors: Ana Fernandez-Bustamante; Soshi Hashimoto; Ary Serpa Neto; Pierre Moine; Marcos F Vidal Melo; John E Repine Journal: BMC Anesthesiol Date: 2015-05-06 Impact factor: 2.217