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Published in: BMC Surgery 1/2018

Open Access 01-12-2018 | Research article

Obesity paradox in patients undergoing lung lobectomy – myth or reality?

Authors: Lubomír Tulinský, Marcel Mitták, Hana Tomášková, Petr Ostruszka, Igor Penka, Peter Ihnát

Published in: BMC Surgery | Issue 1/2018

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Abstract

Background

The aim of the present study was to evaluate the impact of BMI on the short-term outcomes of patients undergoing lung lobectomy.

Methods

This was a retrospective clinical cohort study conducted in a single institution to assess the short-term outcomes of obese patients undergoing lung resection. Intraoperative and postoperative parameters were compared between the two study subgroups: obese (BMI ≥30 kg/m2) and non-obese patients (BMI < 30 kg/m2).

Results

In total, 203 patients were enrolled in the study (70 obese and 133 non-obese patients). Both study subgroups were comparable with regards to demographics, clinical data and surgical approach (thoracoscopy vs. thoracotomy). The surgery time was significantly longer in obese patients (p = 0.048). There was no difference in the frequency of intraoperative complications between the study subgroups (p = 0.635).
The postoperative hospital stay was similar in both study subgroups (p = 0.366). A 30-day postoperative morbidity was higher in a subgroup of non-obese patients (33.8% vs. 21.7%), but the difference was not significant (p = 0.249). In the subgroup of non-obese patients, a higher frequency of mild and severe postoperative complications was observed. However, the differences between the study subgroups were not statistically significant due to the borderline p-value (p = 0.053). The 30-day postoperative mortality was comparable between obese and non-obese patients (p = 0.167).

Conclusions

Obesity does not increase the incidence and severity of intraoperative and postoperative complications after lung lobectomy. Slightly better outcomes in obese patients indicate that obesity paradox might be a reality in patients undergoing lung resection.
Literature
1.
go back to reference Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014;136(5):e359–86.CrossRefPubMed Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014;136(5):e359–86.CrossRefPubMed
2.
go back to reference Berry MF, Hanna J, Tong BC, et al. Risk factors for morbidity after lobectomy for lung Cancer in elderly patients. Ann Thorac Surg. 2009;88:1093–9.CrossRefPubMed Berry MF, Hanna J, Tong BC, et al. Risk factors for morbidity after lobectomy for lung Cancer in elderly patients. Ann Thorac Surg. 2009;88:1093–9.CrossRefPubMed
3.
go back to reference Stéphan FCA, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000;118:1263–70.CrossRefPubMed Stéphan FCA, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000;118:1263–70.CrossRefPubMed
4.
go back to reference Israelsson LA, Jonsson T. Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg. 1997;163:175–80.PubMed Israelsson LA, Jonsson T. Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg. 1997;163:175–80.PubMed
5.
go back to reference Bamgbade OA, Rutter TW, Nafiu OO, Dorje P. Postoperative complications in obese and nonobese patients. World J Surg. 2007;31:556–60.CrossRefPubMed Bamgbade OA, Rutter TW, Nafiu OO, Dorje P. Postoperative complications in obese and nonobese patients. World J Surg. 2007;31:556–60.CrossRefPubMed
6.
go back to reference Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Am Surg. 1995;61:1001–5.PubMed Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Am Surg. 1995;61:1001–5.PubMed
7.
go back to reference Brandt M. Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery. Eur J Cardiothorac Surg. 2001;19:662–6.CrossRefPubMed Brandt M. Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery. Eur J Cardiothorac Surg. 2001;19:662–6.CrossRefPubMed
8.
go back to reference Wigfield CH, Lindsey JD, Muñoz A, Chopra PS, Edwards NM, Love RB. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI≥40. Eur J Cardiothorac Surg. 2006;29:434–40.CrossRefPubMed Wigfield CH, Lindsey JD, Muñoz A, Chopra PS, Edwards NM, Love RB. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI≥40. Eur J Cardiothorac Surg. 2006;29:434–40.CrossRefPubMed
9.
go back to reference Kuduvalli M, Grayson A, Oo A, Fabri B, Rashid A. Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2002;22:787–93.CrossRefPubMed Kuduvalli M, Grayson A, Oo A, Fabri B, Rashid A. Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2002;22:787–93.CrossRefPubMed
10.
go back to reference Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term andlong-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002;39:578–84.CrossRefPubMed Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term andlong-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002;39:578–84.CrossRefPubMed
11.
go back to reference Hainer V, Aldhoon-Hainerova I. Obesity paradox does exist. Diabetes Care. 2013;36:276–81.CrossRef Hainer V, Aldhoon-Hainerova I. Obesity paradox does exist. Diabetes Care. 2013;36:276–81.CrossRef
12.
go back to reference Stamou SC, Nussbaum M, Stiegel RM, et al. Effect of body mass index on outcomes after cardiac surgery: is there an obesity paradox? Ann Thorac Surg. 2011;91:42–7.CrossRefPubMed Stamou SC, Nussbaum M, Stiegel RM, et al. Effect of body mass index on outcomes after cardiac surgery: is there an obesity paradox? Ann Thorac Surg. 2011;91:42–7.CrossRefPubMed
13.
go back to reference Le-Bert G, Santana O, Pineda AM, Zamora C, Lamas GA, Lamelas J. The obesity paradox in elderly obese patients undergoing coronary artery bypass surgery. Interact Cardiovasc Thorac Surg. 2011;13:124–7.CrossRefPubMed Le-Bert G, Santana O, Pineda AM, Zamora C, Lamas GA, Lamelas J. The obesity paradox in elderly obese patients undergoing coronary artery bypass surgery. Interact Cardiovasc Thorac Surg. 2011;13:124–7.CrossRefPubMed
14.
go back to reference Seely AJ, Ivanovic J, Threader J, et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010;90:936–42.CrossRefPubMed Seely AJ, Ivanovic J, Threader J, et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010;90:936–42.CrossRefPubMed
15.
go back to reference Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg. 2006;244:420–5.PubMedPubMedCentral Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg. 2006;244:420–5.PubMedPubMedCentral
16.
go back to reference Daniels LJ, Balderson SS, Onaitis MW, D’Amico TA. Thoracoscopic lobectomy: a safe and effective strategy for patients with stage i lung cancer. Ann Thorac Surg. 2002;74:860–4.CrossRefPubMed Daniels LJ, Balderson SS, Onaitis MW, D’Amico TA. Thoracoscopic lobectomy: a safe and effective strategy for patients with stage i lung cancer. Ann Thorac Surg. 2002;74:860–4.CrossRefPubMed
17.
go back to reference Levin NW, Handelman GJ, Coresh J, Port FK, Kaysen GA. Reverse epidemiology: a confusing, confounding, and inaccurate term. Semin Dial. 2007;20:586–92.CrossRefPubMed Levin NW, Handelman GJ, Coresh J, Port FK, Kaysen GA. Reverse epidemiology: a confusing, confounding, and inaccurate term. Semin Dial. 2007;20:586–92.CrossRefPubMed
18.
go back to reference Fleischmann E, Teal N, Dudley J, May W, Bower JD, Salahudeen AK. Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int. 1999;55:1560–7.CrossRefPubMed Fleischmann E, Teal N, Dudley J, May W, Bower JD, Salahudeen AK. Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int. 1999;55:1560–7.CrossRefPubMed
19.
go back to reference Wang L, Liu W, He X, et al. Association of overweight and obesity with patient mortality after acute myocardial infarction: a meta-analysis of prospective studies. Int J Obes. 2015;40:220–8.CrossRef Wang L, Liu W, He X, et al. Association of overweight and obesity with patient mortality after acute myocardial infarction: a meta-analysis of prospective studies. Int J Obes. 2015;40:220–8.CrossRef
20.
go back to reference Vemmos K, Ntaios G, Spengos K, et al. Association between obesity and mortality after acute first-ever stroke: the obesity-stroke paradox. Stroke. 2010;42:30–6.CrossRefPubMed Vemmos K, Ntaios G, Spengos K, et al. Association between obesity and mortality after acute first-ever stroke: the obesity-stroke paradox. Stroke. 2010;42:30–6.CrossRefPubMed
21.
go back to reference Stein PD, Matta F, Goldman J. Obesity and pulmonary embolism: the mounting evidence of risk and the mortality paradox. Thromb Res. 2011;128:518–23.CrossRefPubMed Stein PD, Matta F, Goldman J. Obesity and pulmonary embolism: the mounting evidence of risk and the mortality paradox. Thromb Res. 2011;128:518–23.CrossRefPubMed
22.
go back to reference Barba R, Zapatero A, Losa JE, et al. Body mass index and mortality in patients with acute venous thromboembolism: findings from the RIETE registry. J Thromb Haemost. 2008;6:595–600.CrossRefPubMed Barba R, Zapatero A, Losa JE, et al. Body mass index and mortality in patients with acute venous thromboembolism: findings from the RIETE registry. J Thromb Haemost. 2008;6:595–600.CrossRefPubMed
23.
go back to reference Kim J, Hammar N, Jakobsson K, Luepker RV, Mcgovern PG, Ivert T. Obesity and the risk of early and late mortality after coronary artery bypass graft surgery. Am Heart J. 2003;146:555–60.CrossRefPubMed Kim J, Hammar N, Jakobsson K, Luepker RV, Mcgovern PG, Ivert T. Obesity and the risk of early and late mortality after coronary artery bypass graft surgery. Am Heart J. 2003;146:555–60.CrossRefPubMed
24.
go back to reference Julien JBS, Aldrich MC, Sheng S, et al. Obesity increases operating room time for lobectomy in the society of thoracic surgeons database. Ann Thorac Surg. 2012;94:1841–7.CrossRef Julien JBS, Aldrich MC, Sheng S, et al. Obesity increases operating room time for lobectomy in the society of thoracic surgeons database. Ann Thorac Surg. 2012;94:1841–7.CrossRef
25.
go back to reference Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139:366–78.CrossRefPubMed Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139:366–78.CrossRefPubMed
26.
go back to reference Eichenberger AS, Proietti S, Wicky S, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788–92.CrossRefPubMed Eichenberger AS, Proietti S, Wicky S, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788–92.CrossRefPubMed
27.
go back to reference Tweed WA, Phua WT, Chong KY, et al. Tidal volume, lung hyperinflation and arterial oxygenation during general anaesthesia. Anaesth Intensive Care. 1993;21:806–10.PubMed Tweed WA, Phua WT, Chong KY, et al. Tidal volume, lung hyperinflation and arterial oxygenation during general anaesthesia. Anaesth Intensive Care. 1993;21:806–10.PubMed
28.
go back to reference Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998;87:6574–60. Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998;87:6574–60.
29.
go back to reference Smith PW, Wang H, Gazoni LM, Shen KR, Daniel TM, Jones DR. Obesity does not increase complications after anatomic resection for non-small cell lung cancer. Ann Thorac Surg. 2007;84:1098–106.CrossRefPubMed Smith PW, Wang H, Gazoni LM, Shen KR, Daniel TM, Jones DR. Obesity does not increase complications after anatomic resection for non-small cell lung cancer. Ann Thorac Surg. 2007;84:1098–106.CrossRefPubMed
30.
go back to reference 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;145:1312–8.CrossRefPubMed 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;145:1312–8.CrossRefPubMed
31.
go back to reference Petrella F, Radice D, Borri A, et al. The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg. 2011;39:738–44.CrossRefPubMed Petrella F, Radice D, Borri A, et al. The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg. 2011;39:738–44.CrossRefPubMed
32.
go back to reference Childers DK, Allison DB. The ‘obesity paradox’: a parsimonious explanation for relations among obesity, mortality rate and aging? Int J Obes. 2010;34:1231–8.CrossRef Childers DK, Allison DB. The ‘obesity paradox’: a parsimonious explanation for relations among obesity, mortality rate and aging? Int J Obes. 2010;34:1231–8.CrossRef
Metadata
Title
Obesity paradox in patients undergoing lung lobectomy – myth or reality?
Authors
Lubomír Tulinský
Marcel Mitták
Hana Tomášková
Petr Ostruszka
Igor Penka
Peter Ihnát
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2018
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-018-0395-2

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