Key result
Overweight and obesity linked to ~28% fewer cardiovascular complications after major lung resection.
Why the study?
Obesity has been thought to predispose patients to excess morbidity after lung resection due to decreased diaphragm excursion, reduced lung volumes, and relative immobility, but the relationship of BMI to acute outcomes after major lung resection needed assessment.
Does body mass index affect the risk of acute postoperative complications in patients undergoing major lung resection?
Cohort (n=1,369)
Does body mass index affect the risk of acute postoperative complications in patients undergoing major lung resection?
Odds Ratio: 0.72 (95% CI 0.51–1)
p-value: p=0.048
In patients undergoing major lung resection, being overweight or obese does not increase postoperative complications, whereas being underweight significantly increases the risk of pulmonary complications and operative mortality.
Overweight or obese status may not preclude major lung resection; leaves open whether BMI refines risk models in thoracic surgery.
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.
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Ferguson et al. (2014) conducted a cohort in Major lung resection (n=1,369). Overweight, obese, or very obese BMI (>25) vs. BMI ≤ 25 was evaluated on Cardiovascular complications (OR 0.72, 95% CI 0.51-1.00, p=0.048). Being overweight or obese did not increase complication risk after major lung resection and was associated with fewer cardiovascular complications compared to BMI ≤ 25 (OR 0.72; 95% CI 0.51-1.00; P=0.048).
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