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Thorac Cardiovasc Surg
DOI: 10.1055/a-2072-9869
Original Thoracic

Impact of Extremes of BMI on Outcomes following Lung Resection

Amber Ahmed-Issap 
1   Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
,
Shubham Jain
1   Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
,
Akolade Habib
1   Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
,
Kim Mantio
2   Keele University School of Medicine, Keele, Staffordshire, United Kingdom
,
Angelica Spence
2   Keele University School of Medicine, Keele, Staffordshire, United Kingdom
,
Marko Raseta
3   Department of Statistics, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
,
Udo Abah
1   Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
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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


Publication History

Received: 15 February 2023

Accepted: 11 April 2023

Accepted Manuscript online:
13 April 2023

Article published online:
31 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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