TY - JOUR
T1 - Perioperative Outcomes after Lung Resection in Obese Patients
AU - Paul, Subroto
AU - Andrews, Weston
AU - Osakwe, Nonso C.
AU - Port, Jeffrey L.
AU - Lee, Paul C.
AU - Stiles, Brendon M.
AU - Altorki, Nasser K.
N1 - Publisher Copyright:
© 2015 Georg Thieme Verlag KG Stuttgart. New York.
PY - 2014/7/28
Y1 - 2014/7/28
N2 - Background Obesity is a growing epidemic in the developed world. However, little is known about the impact of obesity on the perioperative morbidity and mortality after lung resection. Patients and Methods We analyzed the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2010 to determine whether obesity is a risk factor for perioperative morbidity and mortality after pulmonary resection. Demographic, clinical, intraoperative, and morbidity and mortality data were collected. Multivariable predictors of morbidity and mortality were determined using regression analysis. Results A total of 5,216 lung resections were identified (1,372 wedges, 3,713 lobectomies, and 131 pneumonectomies). The median age was 66 years and 2,587 (49.6%) were females. The body mass index (BMI, kg/m2) of the patients was as follows: 192 (3.7%)<18.5; 1,727 (33.1%) 18.5 to 24.9; 1,754 (33.6%) 25 to 29.9; and 1,488 (28.5%)>30. In-hospital mortality and all-cause morbidity was 2.4% (n=127) and 14.5% (n=757) for the entire cohort of patients, respectively. BMI was not found to be a predictor of increased mortality or morbidity, even in the morbidly obese (BMI>35). Rather, age, approach (video-assisted thoracoscopic surgery vs. open), parameters assessing performance status, operative time, and preoperative radiation therapy were the predictors of morbidity and mortality. Conversely, being overweight (BMI 25-30) approached significance as a multivariate predictor for decreased pulmonary complications (odds ratio, 0.77 [0.592-1.004]; p=0.054) consistent with the obesity paradox observed after nonbariatric general surgery. Conclusion Our large national study shows that obesity does not negatively impact perioperative mortality and morbidity in patients undergoing lung resection. Surgical resections should not be denied to obese (BMI>30) patients.
AB - Background Obesity is a growing epidemic in the developed world. However, little is known about the impact of obesity on the perioperative morbidity and mortality after lung resection. Patients and Methods We analyzed the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2010 to determine whether obesity is a risk factor for perioperative morbidity and mortality after pulmonary resection. Demographic, clinical, intraoperative, and morbidity and mortality data were collected. Multivariable predictors of morbidity and mortality were determined using regression analysis. Results A total of 5,216 lung resections were identified (1,372 wedges, 3,713 lobectomies, and 131 pneumonectomies). The median age was 66 years and 2,587 (49.6%) were females. The body mass index (BMI, kg/m2) of the patients was as follows: 192 (3.7%)<18.5; 1,727 (33.1%) 18.5 to 24.9; 1,754 (33.6%) 25 to 29.9; and 1,488 (28.5%)>30. In-hospital mortality and all-cause morbidity was 2.4% (n=127) and 14.5% (n=757) for the entire cohort of patients, respectively. BMI was not found to be a predictor of increased mortality or morbidity, even in the morbidly obese (BMI>35). Rather, age, approach (video-assisted thoracoscopic surgery vs. open), parameters assessing performance status, operative time, and preoperative radiation therapy were the predictors of morbidity and mortality. Conversely, being overweight (BMI 25-30) approached significance as a multivariate predictor for decreased pulmonary complications (odds ratio, 0.77 [0.592-1.004]; p=0.054) consistent with the obesity paradox observed after nonbariatric general surgery. Conclusion Our large national study shows that obesity does not negatively impact perioperative mortality and morbidity in patients undergoing lung resection. Surgical resections should not be denied to obese (BMI>30) patients.
KW - BMI
KW - lung resection
KW - obese
KW - perioperative outcomes
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U2 - 10.1055/s-0034-1383720
DO - 10.1055/s-0034-1383720
M3 - Article
C2 - 25068773
AN - SCOPUS:84944176035
SN - 0171-6425
VL - 63
SP - 544
EP - 550
JO - Thoracic and Cardiovascular Surgeon
JF - Thoracic and Cardiovascular Surgeon
IS - 7
ER -