Impact of Extremes of BMI on Outcomes following Lung Resection

Abstract

Background Body mass index (BMI) has been shown to be an independent predictor of survival following lung resection surgery. This study aimed to quantify the short- to midterm impact of abnormal BMI on postoperative outcomes.

Methods Lung resections at a single institution were examined between 2012 and 2021. Patients were divided into low BMI (<18.5), normal/high BMI (18.5–29.9), and obese BMI (>30). Postoperative complications, length of stay, and 30- and 90-day mortality were examined.

Results A total of 2,424 patients were identified. Of these patients, 2.6% (n = 62) had a low BMI, 67.4% (n = 1,634) had a normal/high BMI, and 30.0% (n = 728) had an obese BMI. Overall postoperative complications were higher in the low BMI group (43.5%) when compared with normal/high (30.9%) and obese BMI group (24.3%) (p = 0.0002). Median length of stay was significantly higher in the low BMI group (8.3 days) compared with 5.2 days in the normal/high and obese BMI groups (p < 0.0001). Ninety-day mortality was higher in the low (16.1%) compared with the normal/high (4.5%) and obese BMI groups (3.7%) (p = 0.0006). Subgroup analysis of the obese cohort did not elucidate any statistically significant differences in overall complications in the morbidly obese. Multivariate analysis determined that BMI is an independent predictor of reduced postoperative complications (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94–0.97; p < 0.0001) and 90-day mortality (OR, 0.96; 95% CI, 0.92–0.99; p = 0.02).

Conclusion Low BMI is associated with significantly worse postoperative outcomes and an approximate fourfold increase in mortality. In our cohort, obesity is associated with reduced morbidity and mortality following lung resection surgery, confirming the existence of the obesity paradox.

Keywords

lung cancer treatment - outcomes - obesity - surgery - complications

Publikationsverlauf

Eingereicht: 15. Februar 2023

Angenommen: 11. April 2023

Accepted Manuscript online:
13. April 2023

Artikel online veröffentlicht:
31. Januar 2024

• References

• 1 Valentijn TM, Galal W, Tjeertes EK, Hoeks SE, Verhagen HJ, Stolker RJ. The obesity paradox in the surgical population. Surgeon 2013; 11 (03) 169-176
• 2 Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298 (17) 2028-2037
• 3 Whitlock G, Lewington S, Sherliker P. et al; Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373 (9669): 1083-1096
• 4 Park Y, Peterson LL, Colditz GA. The plausibility of obesity paradox in cancer-point. Cancer Res 2018; 78 (08) 1898-1903
• 5 Icard P, Schussler O, Loi M. et al. Pre-disease and pre-surgery BMI, weight loss and sarcopenia impact survival of resected lung cancer independently of tumor stage. Cancers (Basel) 2020; 12 (02) 266
• 6 Mullen JT, Moorman DW, Davenport DL. The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 2009; 250 (01) 166-172
• 7 Ferguson MK, Im HK, Watson S, Johnson E, Wigfield CH, Vigneswaran WT. Association of body mass index and outcomes after major lung resection. Eur J Cardiothorac Surg 2014; 45 (04) e94-e99 , discussion e99
• 8 Wang C, Guo M, Zhang N, Wang G. Association of body mass index and outcomes following lobectomy for non-small-cell lung cancer. World J Surg Oncol 2018; 16 (01) 90
• 9 Launer H, Nguyen DV, Cooke DT. National perioperative outcomes of pulmonary lobectomy for cancer in the obese patient: a propensity score matched analysis. J Thorac Cardiovasc Surg 2013; 145 (05) 1312-1318
• 10 Suemitsu R, Sakoguchi T, Morikawa K, Yamaguchi M, Tanaka H, Takeo S. Effect of body mass index on perioperative complications in thoracic surgery. Asian Cardiovasc Thorac Ann 2008; 16 (06) 463-467
• 11 World Health Organization. Obesity and overweight [Internet]. 2021 Accessed May 10, 2022 at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
• 12 UK Parliament. Obesity statistics [Internet]. 2022 Accessed May 13, 2022 at: https://commonslibrary.parliament.uk/research-briefings/sn03336/
• 13 Hemmings HC, Hopkins PM. Foundations of Anesthesia: Basic and Clinical Sciences. Mosby Incorporated; 2000
• 14 Domínguez-Cherit G, Gonzalez R, Borunda D, Pedroza J, Gonzalez-Barranco J, Herrera MF. Anesthesia for morbidly obese patients. World J Surg 1998; 22 (09) 969-973
• 15 Eichenberger A, Proietti S, Wicky S. et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002; 95 (06) 1788-1792
• 16 Agarwal N, Shibutani K, SanFilippo JA, Del Guercio LR. Hemodynamic and respiratory changes in surgery of the morbidly obese. Surgery 1982; 92 (02) 226-234
• 17 Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Effects of obesity and small body size on operative and long-term outcomes of coronary artery bypass surgery: a propensity-matched analysis. Ann Thorac Surg 2005; 79 (06) 1976-1986
• 18 Fernandez FG, Kosinski AS, Burfeind W. et al. The Society of Thoracic Surgeons lung cancer resection risk model: higher quality data and superior outcomes. Ann Thorac Surg 2016; 102 (02) 370-377
• 19 Thomas PA, Berbis J, Falcoz PE. et al; EPITHOR Group. National perioperative outcomes of pulmonary lobectomy for cancer: the influence of nutritional status. Eur J Cardiothorac Surg 2014; 45 (04) 652-659 , discussion 659
• 20 Parini S, Azzolina D, Massera F. et al. The overweight paradox: impact of body mass index on patients undergoing VATS lobectomy or segmentectomy. Semin Thorac Cardiovasc Surg 2023; 35 (01) 164-176
• 21 Gómez-Hernández MT, Fuentes MG, Novoa NM, Rodríguez I, Varela G, Jiménez MF. “Obesity paradox” has not an impact on minimally invasive anatomical lung resection. Cir Esp (Engl Ed) 2022; 100 (05) 288-294
• 22 Barbi J, Patnaik SK, Pabla S. et al. Visceral obesity promotes lung cancer progression-toward resolution of the obesity paradox in lung cancer. J Thorac Oncol 2021; 16 (08) 1333-1348
• 23 Nakagawa T, Toyazaki T, Chiba N, Ueda Y, Gotoh M. Prognostic value of body mass index and change in body weight in postoperative outcomes of lung cancer surgery. Interact Cardiovasc Thorac Surg 2016; 23 (04) 560-566
• 24 Antonopoulos AS, Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc Res 2017; 113 (09) 1074-1086
• 25 Manolopoulos KN, Karpe F, Frayn KN. Gluteofemoral body fat as a determinant of metabolic health. Int J Obes 2010; 34 (06) 949-959
• 26 Attaran S, McShane J, Whittle I, Poullis M, Shackcloth M. A propensity-matched comparison of survival after lung resection in patients with a high versus low body mass index. Eur J Cardiothorac Surg 2012; 42 (04) 653-658
• 27 Zhao H, Li L, Yang G. et al. Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery: a meta-analysis. Medicine (Baltimore) 2019; 98 (06) e14388
• 28 Gupta H, Ramanan B, Gupta PK. et al. Impact of COPD on postoperative outcomes: results from a national database. Chest 2013; 143 (06) 1599-1606
• 29 Roy E, Rheault J, Pigeon MA. et al. Lung cancer resection and postoperative outcomes in COPD: a single-center experience. Chron Respir Dis 2020; 17: 1479973120925430