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Moreno C, Ureña A, Macia I, Rivas F, Déniz C, Muñoz A, Serratosa I, Poltorak V, Moya-Guerola M, Masuet-Aumatell C, Escobar I, Ramos R. The Influence of Preoperative Nutritional and Systemic Inflammatory Status on Perioperative Outcomes following Da Vinci Robot-Assisted Thoracic Lung Cancer Surgery. J Clin Med 2023; 12:jcm12020554. [PMID: 36675482 PMCID: PMC9863584 DOI: 10.3390/jcm12020554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Background: Nutrition is an important factor in the outcome of any disease process. We evaluated the relationship of nutritional status and inflammatory status of non-small cell lung cancer (NSCLC) patients undergoing robotic-assisted thoracic surgery (RATS) with postoperative complications. Methods: This prospective cohort study included 107 NSCLC patients undergoing surgical treatment, between 2019 and 2021. Nutritional status and inflammatory status were assessed before pulmonary resection using anthropometric assessment, blood tests, and body mass index (BMI). Results: The BMI was 27.5 ± 4.4. Based on BMI, 29% (n = 31) were classified as normal weight, 43% (n = 46) as overweight, and 28% (n = 30) as obese. The mean neutrophil/lymphocyte ratio (NLR) was 2.16 ± 0.85, the platelet/lymphocyte ratio (PLR) was 121.59 ± 44.21, and the lymphocyte/monocyte ratio (LMR) was 3.52 ± 1.17. There was no increase in the number of intraoperative complications or bleeding (p = 0.696), postoperative complications (p = 0.569), mean hospital stay (p = 0.258) or duration of chest drain (p = 0.369). Higher inflammatory status, with an NLR > 1.84, was associated with more overall postoperative complications (p = 0.028), only in univariate analysis, but this significance was not maintained on multivariate analysis. Conclusions: BMI was not a predictor of increased postoperative risk in this cohort; therefore, weight should not deter surgeons from using RATS for pulmonary resection.
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Affiliation(s)
- Camilo Moreno
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ivan Macia
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Muñoz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ines Serratosa
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Violeta Poltorak
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Miguel Moya-Guerola
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-933-357-011
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2
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Parini S, Azzolina D, Massera F, Mastromarino MG, Papalia E, Baietto G, Curcio C, Crisci R, Rena O, Alloisio M, Amore D, Ampollini L, Ardò N, Argnani D, Baisi A, Bandiera A, Benato C, Benvenuti MR, Bertani A, Bortolotti L, Bottoni E, Breda C, Camplese P, Carbognani P, Cardillo G, Carleo F, Cavallesco G, Cherchi R, De Palma A, Dell'Amore A, Della Beffa V, Divisi D, Dolci G, Droghetti A, Ferrari P, Fontana D, Gasparri R, Gavezzoli D, Ghisalberti M, Giovanardi M, Gonfiotti A, Guerrera F, Imperatori A, Infante M, Lausi P, Lo Giudice F, Londero F, Lopez C, Mancuso M, Maniscalco P, Margaritora S, Marulli G, Mazza F, Meacci E, Melloni G, Morelli A, Mucilli F, Natali P, Negri G, Nicotra S, Nosotti M, Paladini P, Pariscenti G, Perkmann R, Pernazza F, Pirondini E, Puma F, Raveglia F, Refai M, Rinaldo A, Risso C, Rizzardi G, Rotolo N, Scarci M, Solli P, Sollitto F, Spaggiari L, Stefani A, Stella F, Surrente C, Tancredi G, Terzi A, Torre M, Tosi D, Vinci D, Viti A, Voltolini L, Zaraca F. The Overweight Paradox: Impact of Body Mass Index on Patients Undergoing VATS Lobectomy or Segmentectomy. Semin Thorac Cardiovasc Surg 2023; 35:164-176. [PMID: 35182733 DOI: 10.1053/j.semtcvs.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
Abstract
The aim of this study was to assess the impact of BMI on perioperative outcomes in patients undergoing VATS lobectomy or segmentectomy. Data from 5088 patients undergoing VATS lobectomy or segmentectomy, included in the VATS Group Italian Registry, were collected. BMI (kg/m2) was categorized according to the WHO classes: underweight, normal, overweight, obese. The effects of BMI on outcomes (complications, 30-days mortality, DFS and OS) were evaluated with a linear regression model, and with a logistic regression model for binary endpoints. In overweight and obese patients, operative time increased with BMI value. Operating room time increased by 5.54 minutes (S.E. = 1.57) in overweight patients, and 33.12 minutes (S.E. = 10.26) in obese patients (P < 0.001). Compared to the other BMI classes, overweight patients were at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications. In the overweight range, a BMI increase from 25 to 29.9 did not significantly affect the length of stay, nor the risk of any complications, except for renal complications (OR: 1.55; 95% CI: 1.07-2.24; P = 0.03), and it reduced the risk of prolonged air leak (OR: 0.8; 95% CI: 0.71-0.90; P < 0.001). 30-days mortality is higher in the underweight group compared to the others. We did not find any significant difference in DFS and OS. According to our results, obesity increases operating room time for VATS major lung resection. Overweight patients are at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications following VATS resections. The risk of most postoperative complications progressively increases as the BMI deviates from the point at the lowest risk, towards both extremes of BMI values. Thirty days mortality is higher in the underweight group, with no differences in DFS and OS.
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Affiliation(s)
- Sara Parini
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy; Università degli Studi di Torino, Turin, Italy
| | - Danila Azzolina
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabio Massera
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | | | - Esther Papalia
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Guido Baietto
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Carlo Curcio
- Division of Thoracic Surgery, Ospedale Monaldi, Naples, Italy
| | - Roberto Crisci
- Division of Thoracic Surgery, Ospedale G. Mazzini, Teramo, Italy
| | - Ottavio Rena
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy; Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.
| | | | | | - Dario Amore
- Division of Thoracic Surgery, Ospedale Monaldi, Naples, Italy
| | - Luca Ampollini
- Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicoletta Ardò
- Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Foggia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Duilio Divisi
- Division of Thoracic Surgery, Ospedale G. Mazzini, Teramo, Italy
| | | | | | | | | | | | | | | | | | | | - Francesco Guerrera
- AOU Città della Salute e della Scienza di Torino, Ospedale Molinette, Torino, Italy
| | | | | | - Paolo Lausi
- AOU Città della Salute e della Scienza di Torino, Ospedale Molinette, Torino, Italy
| | | | | | | | - Maurizio Mancuso
- Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Pio Maniscalco
- Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | | | | | | | - Elisa Meacci
- Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | | | | | - Pamela Natali
- Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | | | - Mario Nosotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | - Fausto Pernazza
- Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Francesco Puma
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | | | - Majed Refai
- Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Carlo Risso
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Nicola Rotolo
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | | | | | | | | | | | | | - Alberto Terzi
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Massimo Torre
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Davide Tosi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Damiano Vinci
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Andrea Viti
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Luca Voltolini
- AOUC Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
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Tulinský L, Sengul I, Ihnát P, Ostruszka P, Toman D, Guňková P, Pelikán A, Sengul D. Obesity in cases undergoing the surgical procedure of lung lobectomy: risk or benefit? Rev Assoc Med Bras (1992) 2022; 68:1090-1095. [PMID: 36134838 PMCID: PMC9574992 DOI: 10.1590/1806-9282.20220526] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: The aim of the study was to evaluate the effect of body mass index on patients’ short-term results following lung lobectomy. METHODS: In this retrospective study, we compared the perioperative and short-term postoperative results of obese (BMI≥30 kg/m2) versus non-obese patients (BMI<30 kg/m2) who underwent anatomical lung resection for cancer. The two groups had the same distribution of input risk factors and the same ratio of surgical approaches (thoracoscopy vs. thoracotomy). RESULTS: The study included a total of 144 patients: 48 obese and 96 non-obese patients. Both groups had the same ratio of thoracoscopic vs. thoracotomy approach (50/50%), and were comparable in terms of demographics and clinical data. The g roups did not significantly differ in the frequency of perioperative or postoperative complications. Postoperative morbidity was higher among non-obese patients (34.4 vs. 27.1%), but this difference was not statistically significant (p=0.053). Hospital stay was similar in both study groups (p=0.100). Surgery time was significantly longer among obese patients (p=0.133). Postoperative mortality was comparable between the study groups (p=0.167). CONCLUSIONS: Obesity does not increase the frequency of perioperative and postoperative complications in patients after lung lobectomy. The slightly better results in obese patients suggest that obesity may have some protective role.
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Affiliation(s)
- Lubomír Tulinský
- University Hospital Ostrava, Department of Surgery - Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies - Ostrava, Czech Republic
| | - Ilker Sengul
- Giresun University, Faculty of Medicine, Division of Endocrine Surgery - Giresun, Turkey.,Giresun University, Faculty of Medicine, Department of Surgery - Giresun, Turkey
| | - Peter Ihnát
- University Hospital Ostrava, Department of Surgery - Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies - Ostrava, Czech Republic
| | - Petr Ostruszka
- University Hospital Ostrava, Department of Surgery - Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies - Ostrava, Czech Republic
| | - Daniel Toman
- University Hospital Ostrava, Department of Surgery - Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies - Ostrava, Czech Republic
| | - Petra Guňková
- University Hospital Ostrava, Department of Surgery - Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies - Ostrava, Czech Republic
| | - Anton Pelikán
- University Hospital Ostrava, Department of Surgery - Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies - Ostrava, Czech Republic.,Tomas Bata University in Zlin, Faculty of Humanities - Zlin, Czech Republic
| | - Demet Sengul
- Giresun University, Faculty of Medicine, Department of Pathology - Giresun, Turkey
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Qu C, Li R, Ma Z, Han J, Yue W, Aigner C, Casiraghi M, Tian H. Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges. Transl Lung Cancer Res 2022; 11:1108-1118. [PMID: 35832453 PMCID: PMC9271441 DOI: 10.21037/tlcr-22-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common malignancy and one of the most common causes of cancer-related death worldwide. Robotic-assisted thoracic surgery (RATS) has gradually become a prevalent surgical method for patients with NSCLC. Previous studies have found that body mass index (BMI) is associated with postoperative outcomes. This study aimed to investigate the effectiveness of RATS compared to video-assisted thoracic surgery (VATS) in the treatment of NSCLC with different BMI, in terms of perioperative outcomes. Methods The baseline and perioperative data, including BMI, of 849 NSCLC patients who underwent minimally invasive anatomic lung resections from August 2020 to April 2021 were retrospectively collected and analyzed. Propensity score matching analysis was applied to minimize potential bias between the two groups (VATS and RATS), and the perioperative outcomes were compared. Subgroup analysis was subsequently performed. Results Compared to VATS, RATS had more lymph nodes dissected {9 [inter-quartile range (IQR), 6–12] vs. 7 (IQR, 6–10), P<0.001}, a lower estimated bleeding volume [40 (IQR, 30–50) vs. 50 (IQR, 40–60) mL, P<0.001], and other better postoperative outcomes, but a higher cost of hospitalization [¥83,626 (IQR, 77,211–92,686) vs. ¥75,804 (IQR, 66,184–83,693), P<0.001]. Multivariable logistic regression analysis indicated that RATS (P=0.027) and increasing BMI (P=0.030) were associated with a statistically significant reduction in the risk of postoperative complications. Subgroup analysis indicated that the advantages of RATS may be more obvious in patients with a BMI of 24–28 kg/m2, in which the RATS group had more lymph nodes dissected [9 (IQR, 6–12) vs. 7 (IQR, 5–10), P<0.001] and a decreased risk of total postoperative complications [odds ratio (OR), 0.443; 95% confidence interval (CI), 0.212–0.924; P=0.030] compared to the VATS group. Conclusions Both, RATS and VATS can be safely applied for patients with NSCLC. Perioperative outcome parameters indicate advantages for RATS, however at a higher cost of hospitalization. The advantages of RATS might be more obvious in patients with a BMI of 24–28 kg/m2.
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Affiliation(s)
- Chenghao Qu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Rongyang Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zheng Ma
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jingyi Han
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Weiming Yue
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology-IEO IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
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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 2022; 100:288-294. [PMID: 35598956 DOI: 10.1016/j.cireng.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/18/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The paradoxical benefit of obesity, the 'obesity paradox', has been analyzed in lung surgical populations with contradictory results. Our goal was assessing the relationship of body mass index (BMI) to acute outcomes after minimally invasive major pulmonary resections. METHODS Retrospective review of consecutive patients who underwent pulmonary anatomical resection through a minimally invasive approach for the period 2014-2019. Patients were grouped as underweight, normal, overweight and obese type I, II and III. Adjusted odds ratios regarding postoperative complications (overall, respiratory, cardiovascular and surgical morbidity) were produced with their exact 95% confidence intervals. All tests were considered statistically significant at p<0.05. RESULTS Among 722 patients included in the study, 37.7% had a normal BMI and 61.8% were overweight or obese patients. When compared with that of normal BMI patients, adjusted pulmonary complications were significantly higher in obese type I patients (2.6% vs 10.6%, OR: 4.53 [95%CI: 1.86-12.11]) and obese type II-III (2.6% vs 10%, OR: 6.09 [95%CI: 1.38-26.89]). No significant differences were found regarding overall, cardiovascular or surgical complications among groups. CONCLUSIONS Obesity has not favourable effects on early outcomes in patients undergoing minimally invasive anatomical lung resections, since the risk of respiratory complications in patients with BMI≥30kg/m2 and BMI≥35kg/m2 is 4.5 and 6 times higher than that of patients with normal BMI.
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Affiliation(s)
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Israel Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research (IBSAL), Spain
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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 2021; 100:S0009-739X(21)00040-3. [PMID: 33637296 DOI: 10.1016/j.ciresp.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The paradoxical benefit of obesity, the 'obesity paradox', has been analyzed in lung surgical populations with contradictory results. Our goal was assessing the relationship of body mass index (BMI) to acute outcomes after minimally invasive major pulmonary resections. METHODS Retrospective review of consecutive patients who underwent pulmonary anatomical resection through a minimally invasive approach for the period 2014-2019. Patients were grouped as underweight, normal, overweight and obese type I, II and III. Adjusted odds ratios regarding postoperative complications (overall, respiratory, cardiovascular and surgical morbidity) were produced with their exact 95% confidence intervals. All tests were considered statistically significant at p<0.05. RESULTS Among 722 patients included in the study, 37.7% had a normal BMI and 61.8% were overweight or obese patients. When compared with that of normal BMI patients, adjusted pulmonary complications were significantly higher in obese type I patients (2.6% vs 10.6%, OR: 4.53 [95%CI: 1.86-12.11]) and obese type II-III (2.6% vs 10%, OR: 6.09 [95%CI: 1.38-26.89]). No significant differences were found regarding overall, cardiovascular or surgical complications among groups. CONCLUSIONS Obesity has not favourable effects on early outcomes in patients undergoing minimally invasive anatomical lung resections, since the risk of respiratory complications in patients with BMI≥30kg/m2 and BMI≥35kg/m2 is 4.5 and 6 times higher than that of patients with normal BMI.
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Affiliation(s)
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Israel Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research (IBSAL), Spain
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The Role of Obesity in Early and Long-Term Outcomes after Surgical Excision of Lung Oligometastases from Colorectal Cancer. J Clin Med 2020; 9:jcm9113566. [PMID: 33167545 PMCID: PMC7694523 DOI: 10.3390/jcm9113566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Obesity correlates with better outcomes in many neoplastic conditions. The aim of this study was to assess its role in the prognosis and morbidity of patients submitted to resection of lung oligometastases from colorectal cancer. Seventy-six patients undergoing a first pulmonary metastasectomy were retrospectively included in the study. Seventeen (22.3%) were obese (body mass index (BMI) >30 kg/m2). Assessed outcomes were overall survival, time to recurrence, and incidence of post-operative complications. Median follow-up was 33 months (IQR 16-53). At follow-up, 37 patients (48.6%) died, whereas 39 (51.4%) were alive. A significant difference was found in the 3-year overall survival (obese 80% vs. non-obese 56.8%, p = 0.035). Competing risk analysis shows that the cumulative incidence of recurrence was not different between the two groups. Multivariate analysis reveals that the number of metastases (p = 0.028), post-operative pneumonia (p = 0.042), and DFS (p = 0.007) were significant predictors of death. Competing risk regression shows that no independent risk factor for recurrence has been identified. The complication rate was not different between the two groups (17.6% vs. 13.6%, p = 0.70). Obesity is a positive prognostic factor for survival after pulmonary metastasectomy for colorectal cancer. Overweight patients do not experience more post-operative complications. Our results need to be confirmed by large multicenter studies.
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Multilevel Body Composition Analysis on Chest Computed Tomography Predicts Hospital Length of Stay and Complications After Lobectomy for Lung Cancer. Ann Surg 2020; 275:e708-e715. [DOI: 10.1097/sla.0000000000004040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Casiraghi M, Sedda G, Diotti C, Mariolo AV, Galetta D, Tessitore A, Maisonneuve P, Spaggiari L. Postoperative outcomes of robotic-assisted lobectomy in obese patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2019; 30:359-365. [DOI: 10.1093/icvts/ivz273] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to assess the postoperative outcomes of robotic-assisted lobectomy in obese patients to determine the impact of the robotic approach on a high-risk population who were candidates for major pulmonary resection for non-small-cell lung cancer (NSCLC).
METHODS
Between January 2007 and August 2018, we retrospectively reviewed the medical records of 224 obese patients (body mass index ≥ 30) who underwent pulmonary lobectomy at our institution via robotic-assisted thoracic surgery (RATS, n = 51) or lateral muscle-sparing thoracotomy (n = 173).
RESULTS
Forty-two patients were individually matched with those who had the same pathological tumour stage and similar comorbidities and presurgical treatment. The median operative time was significantly longer in the RATS group compared to that in the thoracotomy group (200 vs 158 min; P = 0.003), whereas the length of stay was significantly better for the RATS group (5 vs 6 days; P = 0.047). Postoperative complications were significantly more frequent after open lobectomy than in the RATS group (42.9% vs 16.7%; P = 0.027). After a median follow-up of 4.4 years, the 5-year overall survival rate was 67.6% [95% confidence interval (CI) 45.7–82.2] for the RATS group, and 66.1% (95% CI 46.8–79.9) for the open surgery group (log-rank P = 0.54). The 5-year cumulative incidence of cancer-related deaths was 24.8% (95% CI 9.7–43.5) for the RATS group and 23.6% (95% CI 10.8–39.2) for the open surgery group (Gray’s test, P = 0.69).
CONCLUSIONS
RATS is feasible and safe for obese patients with NSCLC with advantages compared to open surgery in terms of early postoperative outcomes. In addition, the long-term survival rate was comparable to that of the open approach.
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Affiliation(s)
- Monica Casiraghi
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Giulia Sedda
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Cristina Diotti
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Alessio Vincenzo Mariolo
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Adele Tessitore
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
- Department of Oncology and Hematology (DIPO), School of Medicine, University of Milan, Milan, Italy
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10
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Tulinský L, Mitták M, Tomášková H, Ostruszka P, Penka I, Ihnát P. Obesity paradox in patients undergoing lung lobectomy - myth or reality? BMC Surg 2018; 18:61. [PMID: 30119623 PMCID: PMC6098611 DOI: 10.1186/s12893-018-0395-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Marcel Mitták
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Hana Tomášková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Petr Ostruszka
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Igor Penka
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Peter Ihnát
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic. .,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic.
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11
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Endo S, Ikeda N, Kondo T, Nakajima J, Kondo H, Yokoi K, Chida M, Sato M, Toyooka S, Yoshida K, Okada Y, Sato Y, Okada M, Okumura M, Chihara K, Fukuchi E, Miyata H. Model of lung cancer surgery risk derived from a Japanese nationwide web-based database of 78 594 patients during 2014-2015. Eur J Cardiothorac Surg 2018; 52:1182-1189. [PMID: 28977408 PMCID: PMC5848741 DOI: 10.1093/ejcts/ezx190] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/09/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Using data obtained from a Japanese nationwide annual database with web-based data entry, we developed a risk model of mortality and morbidity after lung cancer surgery. METHODS The characteristics and operative and postoperative data from 80 095 patients who underwent lung cancer surgery were entered into the annual National Clinical Database of Japan data sets for 2014 and 2015. After excluding 1501 patients, the development data set for risk models included 38 277 patients entering in 2014 and the validation data set included 40 317 patients entering in 2015. Receiver–operating characteristic curves were generated for the outcomes of mortality and composite mortality/major morbidity. The concordance index was used to assess the discriminatory ability and validity of the model. RESULTS The 30-day mortality and overall mortality rates, including in-hospital deaths, were 0.4% and 0.8%, respectively, in 2014, and 0.4% and 0.8%, respectively, in 2015. The rate of major morbidity was 5.6% in 2014 and 5.6% in 2015. Several risk factors were significantly associated with mortality, namely, male sex, performance status, comorbidities of interstitial pneumonia and liver cirrhosis, haemodialysis and the surgical procedure pneumonectomy. The concordance index for mortality and composite mortality/major morbidity was 0.854 (P < 0.001) and 0.718 (P < 0.001), respectively, for the development data set and 0.849 (P < 0.001) and 0.723 (P < 0.001), respectively, for the validation data set. CONCLUSIONS This model was satisfactory for predicting surgical outcomes after pulmonary resection for lung cancer in Japan and will aid preoperative assessment and improve clinical outcomes for lung cancer surgery.
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Affiliation(s)
- Shunsuke Endo
- Department of Thoracic Surgery, Jichi Medical University, Tochigi, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takashi Kondo
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Haruhiko Kondo
- Department of General Thoracic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Masami Sato
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shinichi Toyooka
- Department of Thoracic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koichi Yoshida
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Miyagi, Japan
| | - Yukio Sato
- Faculty of Medicine, Department of Thoracic Surgery, University of Tsukuba, Ibaraki, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Chihara
- Division of Thoracic Surgery, Shizuoka Hospital, Shizuoka, Japan
| | - Eriko Fukuchi
- Department of Healthcare Quality Assessment, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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12
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Abstract
The obesity epidemic in the United States has increased greatly over the past several decades, and thoracic surgeons are likely to see obese patients routinely in their practices. Obesity has direct deleterious health effects such as metabolic disorder and cardiovascular disease, and is associated with many cancers. Obese patients who need thoracic surgery pose practical challenges to many of the routine elements in perioperative management. Preoperative assessment of obesity-related comorbid conditions and risk stratification for surgery, thorough intraoperative planning for anesthesia and surgery, and postoperative strategies to optimize pulmonary hygiene and mobility minimize the risk of adverse outcomes.
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Affiliation(s)
- Douglas Z Liou
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Drive, Falk Cardiovascular Research Building, 2nd Floor, Stanford, CA 94305, USA.
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13
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Preoperative nutritional status assessment predicts postoperative outcomes in patients with surgically resected non-small cell lung cancer. Eur J Surg Oncol 2018; 44:1419-1424. [PMID: 29685760 DOI: 10.1016/j.ejso.2018.03.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/25/2018] [Accepted: 03/27/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND As nutritional status plays an important role in outcomes after surgery, this study evaluated the association between preoperative nutritional status (NS) and postoperative outcomes after major resection for lung cancer. METHODS We identified 219 patients with a diagnosis of cancer who underwent pulmonary resection from 2010 to 2012. Preoperative NS was assessed by anthropometric and biological parameters, body mass index (BMI), and the Nutritional Risk Index (NRI). We stratified this population into 4 BMI groups: underweight, normal weight, overweight and obese and 4 NRI groups: well-nourished; mildly malnourished; moderately malnourished and severely malnourished. The outcomes measured were postoperative complications; 30-day postoperative mortality; hospital length of stay (LOS), overall survival (OS) and disease-free survival (DFS). We performed both unadjusted analysis and adjusted multivariable analysis, controlling for statistically significant variables. RESULTS Mean BMI and NRI were, respectively, 26.5 ± 4.3 and 112.4 ± 3.3. There were no significant differences between BMI categories and resection type, pathological stage, or overall postoperative complications. By contrast, significant differences (p < 0.05) in postoperative complications were observed among the NRI groups. LOS was longer in underweight and/or malnourished patients. In terms of OS, we found no significant differences according to NRI and BMI; however, patients with underweight had significantly shorter DFS compared with patients with overweight and obesity (log-rank p-value = 0.001). CONCLUSION NS as measured by the NRI is an independent predictor of the risk of postsurgical complications, regardless of clinicopathologic characteristics. NRI might therefore be an useful tool for identifying early-stage lung cancer patients at risk for postoperative complications.
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14
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Li S, Wang Z, Huang J, Fan J, Du H, Liu L, Che G. Systematic review of prognostic roles of body mass index for patients undergoing lung cancer surgery: does the 'obesity paradox' really exist? Eur J Cardiothorac Surg 2018; 51:817-828. [PMID: 28040677 DOI: 10.1093/ejcts/ezw386] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/26/2016] [Indexed: 01/11/2023] Open
Abstract
Summary The paradoxical benefit of obesity, the 'obesity paradox', has been recently identified in surgical populations. Our goal was to evaluate by a systematic review with meta-analysis the prognostic role of body mass index (BMI) and to identify whether the 'obesity paradox' exists in lung cancer surgery. Comprehensive literature retrieval was conducted in PubMed to identify the eligible articles. The odds ratios (OR) and hazard ratios (HR) with the corresponding 95% confidence intervals (CI) were used to synthesize in-hospital and long-term survival outcomes, respectively. The heterogeneity level and publication bias between studies were also estimated. Finally, 25 observational studies with 78 143 patients were included in this review. The pooled analyses showed a significantly better long-term survival rate in patients with higher BMI, but no significant benefit of increased BMI was found for in-hospital morbidity. The pooled analyses also showed that overall morbidity (OR: 0.84; 95% CI: 0.73-0.98; P = 0.025) and in-hospital mortality (OR: 0.78; 95% CI: 0.63-0.98; P = 0.031) were significantly decreased in obese patients. Obesity could be a strong predictor of the favourable long-term prognosis of lung cancer patients (HR: 0.69; 95% CI: 0.56-0.86; P = 0.001). The robustness of these pooled estimates was strong. No publication bias was detected. In summary, obesity has favourable effects on in-hospital outcomes and long-term survival of surgical patients with lung cancer. The 'obesity paradox' does have the potential to exist in lung cancer surgery.
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15
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Tomita M, Ayabe T, Nakamura K. Low Body Mass Index Is an Independent Predictive Factor after Surgical Resection in Patients with Non-Small Cell Lung Cancer. Asian Pac J Cancer Prev 2017; 18:3353-3356. [PMID: 29286350 PMCID: PMC5980894 DOI: 10.22034/apjcp.2017.18.12.3353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The effect of body mass index (BMI) on postoperative survival in non-small cell lung cancer (NSCLC) has been controversial. We retrospectively analysed the effect of preoperative BMI on postoperative outcomes of NSCLC surgery. Methods: Consecutive 384 NSCLC patients were enrolled. Patients were subdivided into 3 groups: low BMI group (BMI<18.5 kg/m2), normal BMI group (BMI=18.5-24.0 kg/m2) and high BMI group (BMI>24.0 kg/m2). The prognostic significance of BMI was examined retrospectively. Results: The 5-year survival of patients with low, normal and high BMI groups were 46.3%, 74.3% and 84.3%, respectively. The low BMI group had a poorer prognosis than the other groups (p<0.001). The survival of high BMI group had a more favorable trend than that of normal BMI group, but this did not reach statistical significance (p=0.057). On multivariate analysis, significant risk factors for cancer-specific survival were male gender (p=0.0061), non-adenocarcinoma histology (p=0.0003), pN1-2 status (p=0.0007), high serum CEA level (p<0.0001) and low BMI (low vs. others: p <0.0001). Conclusions: Preoperative BMI is an independent prognostic factor for NSCLC patients after surgical resection, with low BMI patients having an unfavorable prognosis.
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Affiliation(s)
- Masaki Tomita
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, Japan.
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16
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Kawai H, Saito Y, Suzuki Y. Gender differences in the correlation between prognosis and postoperative weight loss in patients with non-small cell lung cancer. Interact Cardiovasc Thorac Surg 2017; 25:272-277. [PMID: 28444319 DOI: 10.1093/icvts/ivx092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/25/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate gender differences in the relationship between preoperative body mass index (BMI), postoperative body weight change and prognosis in patients with non-small cell lung cancer (NSCLC). METHODS Two hundred and sixty-three patients with NSCLC were enrolled in this study. Preoperative BMI was categorized based on WHO definition as follows: underweight (BMI <18.5): 21 patients (8.0%), normal (18.5 ≦ BMI <25): 179 patients (68%), overweight and obese (BMI ≧25): 63 patients (24%). Several factors such as age, sex, cancer stage, body weight change and BMI were recorded and correlated to the postoperative overall survival (OS). RESULTS For male patients, those in the low-BMI group had the worst prognosis (P < 0.05) whereas female patients with low BMI did not. Male patients with low BMI had statistically significant poorer prognosis compared to corresponding female patients (P < 0.05). Male patients with more than 5% body weight loss within 1 year after operation when compared to preoperative body weight had poorer prognosis than those with less than 5% body weight loss (P < 0.001). Furthermore, these male patients had statistically significant worse prognosis than the corresponding female patients (P < 0.05). In multivariable analysis, gender, more than 5% of body weight loss compared to preoperative body weight, and pathological stage were independent prognostic factors in NSCLC. CONCLUSIONS This study illustrates significant gender differences in the relationship between prognosis and BMI or body weight change in patients with postoperative NSCLC.
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Affiliation(s)
- Hideki Kawai
- Department of Thoracic Surgery, Akita Red Cross Hospital, Kamikitate, Akita, Japan
| | - Yoshitaro Saito
- Department of Thoracic Surgery, Akita Red Cross Hospital, Kamikitate, Akita, Japan
| | - Yohei Suzuki
- Department of Thoracic Surgery, Akita Red Cross Hospital, Kamikitate, Akita, Japan
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17
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Lang LH, Parekh K, Tsui BYK, Maze M. Perioperative management of the obese surgical patient. Br Med Bull 2017; 124:135-155. [PMID: 29140418 PMCID: PMC5862330 DOI: 10.1093/bmb/ldx041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/10/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The escalation in the prevalence of obesity throughout the world has led to an upsurge in the number of obese surgical patients to whom perioperative care needs to be delivered. SOURCES OF DATA After determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered. AREAS OF AGREEMENT There were no controversies regarding preoperative management and the intraoperative care of the obese surgical patient. AREAS OF CONTROVERSY Is there a healthy obese state that gives rise to the obesity paradox regarding postoperative complications? GROWING POINTS This review considers how to prepare for and manage the obese surgical patient through the entire spectrum, from preoperative assessment to possible postoperative intensive care. AREAS TIMELY FOR DEVELOPING RESEARCH What results in an obese patient developing 'unhealthy' obesity?
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Affiliation(s)
- L H Lang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 1001 Potrero Avenue Box 1363, San Francisco, CA 94143, USA
| | - K Parekh
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 1001 Potrero Avenue Box 1363, San Francisco, CA 94143, USA
| | - B Y K Tsui
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 1001 Potrero Avenue Box 1363, San Francisco, CA 94143, USA
| | - M Maze
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 1001 Potrero Avenue Box 1363, San Francisco, CA 94143, USA
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18
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Williams T, Gulack BC, Kim S, Fernandez FG, Ferguson MK. Operative Risk for Major Lung Resection Increases at Extremes of Body Mass Index. Ann Thorac Surg 2016; 103:296-302. [PMID: 27476820 DOI: 10.1016/j.athoracsur.2016.05.057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/25/2016] [Accepted: 05/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although body mass index (BMI) has been used in risk stratification for lung resection, many models only take obesity into account. Recent studies have demonstrated that underweight patients also experience increased postoperative complications. We explored the relationship of extremes of BMI to outcomes after lung resection for non-small cell cancer. METHODS Patients in the Society of Thoracic Surgeons General Thoracic Surgery Database (2009 to 2014) undergoing elective lung resection for cancer were evaluated. Multivariable logistic regression was used to adjust for potential confounders including functional status and spirometry. RESULTS We evaluated 41,446 patients (median 68 years of age; 53% female) grouped by BMI: underweight (<18.5 kg/m2; 3.0%), normal (18.5 to 24.9 kg/m2; 33.5%), overweight (25 to 29.9 kg/m2; 35.4%), obese I (30 to 34.9 kg/m2; 18.1%), obese II (35 to 39.9 kg/m2; 6.4%), and obese III (≥40 kg/m2; 3.6%). Pulmonary complication rates were higher in underweight and obese III patients compared to normal BMI patients (p < 0.001). On multivariable analysis, compared to patients with normal BMI, being underweight was associated with an increased risk of pulmonary complications (adjusted odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.16 to 1.70) and any postoperative event (adjusted OR: 1.44, 95% CI: 1.26 to 1.64). Obese III patients had an increased risk of any major postoperative complication (adjusted OR: 1.18, 95% CI: 1.02 to 1.36). Overweight and obese class I to II patients had a lower risk of pulmonary complications and any postoperative event. CONCLUSIONS BMI is associated with postoperative complications after lung resection for cancer. Being underweight or severely overweight is associated with an increased risk of complications, whereas being overweight or moderately obese appears to have a protective effect.
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Affiliation(s)
- Trevor Williams
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Sunghee Kim
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Felix G Fernandez
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Mark K Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois; Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois.
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19
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Prognostic value of body mass index and change in body weight in postoperative outcomes of lung cancer surgery. Interact Cardiovasc Thorac Surg 2016; 23:560-6. [DOI: 10.1093/icvts/ivw175] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/26/2016] [Indexed: 12/21/2022] Open
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20
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Brooks RA, Blansit K, Young-Lin N, Usach I, Chen LM, Yu X, Kapp DS, Chan JK. The economic impact of surgical care for morbidly obese endometrial cancer patients: a nationwide study. Am J Obstet Gynecol 2016; 214:498.e1-498.e6. [PMID: 26478102 DOI: 10.1016/j.ajog.2015.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obesity significantly impacts the cost of cancer treatment, yet the impact of morbid obesity on inpatient hospital charges related to endometrial cancer treatment is not well-defined. OBJECTIVES The purpose of this study was to determine the charges that are associated with inpatient surgery, hospitalization, and postoperative care of morbidly obese patients with endometrial cancer. STUDY DESIGN Data were obtained from the National Inpatient Sample from 2010. Chi-square test, t-test, and linear regression were used for statistical analyses. RESULTS Six thousand five hundred sixty patients who underwent hysterectomy for endometrial cancer were identified. Mean age was 62 years (range, 22-99 years). The majority were white (78%), and the remainder were black (10%), Hispanic, (8%), Asian (3%), and Native American (1%). Insurance types were private (45%), Medicare (45%), Medicaid (5%), and uninsured (7%). One thousand eighty-eight of these patients (17%) were coded as morbidly obese. The mean postoperative stay for the morbidly obese was 4.0 days (range, 0-46 days) compared with 3.5 days (range, 0-81 days) for the non-morbidly obese patients (P < .01). Morbidly obese patients required more intensive care with mechanical ventilation (5.5% vs 1.6%; P < .01). The median hospital charges were higher for morbidly obese patients compared with their counterparts ($46,654 vs $41,164; P < .01). After adjustment for charges that were associated with insurance type, hospital type, and the surgery that was performed, the incremental increase in hospital charges that were associated with treating the morbidly obese patient was $5096 per patient (95% confidence interval, $2593-$7598; P < .01). CONCLUSION In this economic analysis, the health care charges that were associated with inpatient endometrial cancer treatment in the morbidly obese patient was significantly higher compared the non-morbidly obese patient. Resources are needed to support the needs of this population, and programs to encourage weight loss and optimize general health should be encouraged.
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Affiliation(s)
- Rebecca A Brooks
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA.
| | - Kevin Blansit
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA
| | - Nichole Young-Lin
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA
| | - Irina Usach
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA
| | - Lee May Chen
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA
| | - Xinhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, TN
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford Cancer Center, Stanford University, Stanford, CA
| | - John K Chan
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA; California Pacific/Palo Alto Medical Foundation, Sutter Research Institute, Palo Alto, CA
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Della Rocca G, Vetrugno L, Coccia C, Pierconti F, Badagliacca R, Vizza CD, Papale M, Melis E, Facciolo F. Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team. J Cardiothorac Vasc Anesth 2015; 30:530-8. [PMID: 27013123 DOI: 10.1053/j.jvca.2015.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Giorgio Della Rocca
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | - Federico Pierconti
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | | | | | | | - Enrico Melis
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
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Non-ventilatory approaches to prevent postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol 2015; 29:397-410. [PMID: 26643103 DOI: 10.1016/j.bpa.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 02/07/2023]
Abstract
This educational narrative review provides a summary of non-ventilatory strategies to prevent postoperative pulmonary complications (PPCs). It highlights patient- and procedure-related risk factors for PPCs that are non-modifiable, potentially modifiable, or well modifiable. Non-ventilatory strategies, mainly based on the modification of risk factors, play a key role in reducing PPCs. Non-modifiable risk factors, most importantly age, American Society of Anesthesiologists (ASA) class, and risk of the procedure, should be recognized and patients intensively screened for the potential to optimize other, potentially or well-modifiable, risk factors. Potentially modifiable risk factors, mainly comorbidities and the surgical approach, increase the risk of PPCs. Patient-related factors can be improved while procedure-related factors may be adapted in high-risk patients. Well-modifiable risk factors, mainly certain anesthesia techniques, for example, general anesthesia, intravenous opioids or liberal fluid management, and smoking or alcohol abuse, should be avoided as far as possible in order to prevent PPCs.
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Su J, Yu P, Zhou Y, Pu Q, He C, Liu L, Che G. [Influencing factor of postoperation fast-track recovery and in hospital cost after lobctomy for lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 17:536-40. [PMID: 25034582 PMCID: PMC6000476 DOI: 10.3779/j.issn.1009-3419.2014.07.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unknown that the postoperation fast-track recovery and in hospital cost of the lobectomy in lung cancer, we explored the influencing factor of postoperative fast-track recovery and in hospital cost after undergoing lobectomy for lung cancer. METHODS We retrospectively reviewed the medical records of all patients (n=176) who underwent lobectomy for lung cancer between January 2010 and November 2011 by a thoracic surgeon. RESULTS The hospital costs of video-assisted thoracic surgery (VATS) lobectomy (47,308.21 ¥) is significantly higher than open lobectomy (45,664.31 ¥)(P=0.007). The hospital costs of body mass index (BMI) ≥ 24 kg/m2 (51,186.99 ¥) is significantly higher than BMI < 24 kg/m2 (41,701.64 ¥)(P=0.032). The hospital stay of VATS lobectomy (5.70 d) is significantly less than open lobectomy (7.10 d)(P<0.001). CONCLUSIONS These findings indicate that preoperative pulmonary rehabilitation and VATS lobectomy is contributed to fast-track recovery for patients who undergo lobectomy, but increase the hospital costs.
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Affiliation(s)
- Jianhua Su
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengming Yu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yubin Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Mungo B, Zogg CK, Hooker CM, Yang SC, Battafarano RJ, Brock MV, Molena D. Does obesity affect the outcomes of pulmonary resections for lung cancer? A National Surgical Quality Improvement Program analysis. Surgery 2015; 157:792-800. [DOI: 10.1016/j.surg.2014.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/16/2014] [Accepted: 10/31/2014] [Indexed: 12/20/2022]
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Rivera C, Pecuchet N, Wermert D, Pricopi C, Le Pimpec-Barthes F, Riquet M, Fabre E. [Obesity and lung cancer: incidence and repercussions on epidemiology, pathology and treatments]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:37-43. [PMID: 25681316 DOI: 10.1016/j.pneumo.2014.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Obesity and lung cancer are major public health problems. The purpose of this work is to review the data concerning this association. METHOD We report clinical and epidemiological data on obesity and discuss the impact on the incidence of lung cancer, as well as the safety and efficiency of anti-tumor treatments. RESULTS Obesity does not contribute to the occurrence of lung cancer, unlike other malignancies. Patients may be more likely to undergo treatment at lower risk. Regarding surgery, obesity makes anaesthesia more difficult, increases the operative duration but does not increase postoperative morbidity and mortality. Chemotherapy and radiotherapy seem to be administered according to the same criteria as patients with normal weight. Paradoxically, survival rates of lung cancer are better in obese patients as well after surgery than after non-surgical treatment. CONCLUSION Obesity is related to many neoplasms but not to lung cancer. Regarding long-term survival all treatments combined, it has a favorable effect: this is the "obesity paradox".
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Affiliation(s)
- C Rivera
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - N Pecuchet
- Unité d'oncologie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - D Wermert
- Service de pneumologie, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - E Fabre
- Unité d'oncologie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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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:e94-9; discussion e99. [PMID: 24504655 DOI: 10.1093/ejcts/ezu008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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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Affiliation(s)
- Mark K Ferguson
- Department of Surgery, The University of Chicago, Chicago, IL, USA
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Thomas PA, Berbis J, Falcoz PE, Le Pimpec-Barthes F, Bernard A, Jougon J, Porte H, Alifano M, Dahan M, Alauzen M, Andro JF, Aubert M, Avaro JP, Azorin J, Bagan P, Bellenot F, Blin V, Boitet P, Bordigoni L, Borrelly J, Brichon PY, Cardot G, Carrie JM, Clement F, Corbi P, Debaert M, Debrueres B, Dubrez J, Ducrocq X, Dujon A, Dumont P, Fernoux P, Filaire M, Frassinetti E, Frey G, Gossot D, Grosdidier G, Guibert B, Hagry O, Jaillard S, Jarry JM, Kaczmarek D, Laborde Y, Lenot B, Levy F, Lombart L, Marcade E, Marcade JP, Marzelle J, Massard G, Mazeres F, Mensier E, Metois D, Michaud J, Paris E, Mondine P, Monteau M, Moreau JM, Mouroux J, Mugniot A, Mulsant P, Naffaa N, Neveu P, Pavy G, Peillon C, Pons F, Porte H, Regnard JF, Riquet M, Looyeh BS, Thomas P, Tiffet O, Tremblay B, Valla J, Velly JF, Wack B, Wagner JD, Woelffe D. National perioperative outcomes of pulmonary lobectomy for cancer: the influence of nutritional status. Eur J Cardiothorac Surg 2013; 45:652-9; discussion 659. [DOI: 10.1093/ejcts/ezt452] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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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. [DOI: 10.1016/j.jtcvs.2012.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/18/2012] [Accepted: 10/02/2012] [Indexed: 11/25/2022]
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Morbidities of lung cancer surgery in obese patients. J Thorac Cardiovasc Surg 2013; 146:379-84. [PMID: 23618391 DOI: 10.1016/j.jtcvs.2013.02.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 01/12/2013] [Accepted: 02/11/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is a risk factor for increased perioperative morbidity and mortality in surgical patients. There have been limited studies to correlate the morbidity of lung cancer resection with obesity. METHODS We performed a retrospective study of patients who underwent surgical resection for lung cancer at the Medical College of Wisconsin, Milwaukee, from 2006 to 2010. Data on patient demographics, weight, pathological findings, and hospital course were abstracted after appropriate institutional review board approval. Perioperative morbidity was defined as atrial fibrillation, heart failure, respiratory failure, pulmonary embolism, or any medical complications arising within 30 days after surgery. The Fisher exact test was used to test the association between body mass index (BMI) and perioperative morbidities. RESULTS Between 2006 and 2010, 320 lung resections were performed for lung cancer. The median age was 67 (interquartile range, 59-75) years, and 185 (57.8%) were females. A total of 121 (37.8%) of patients had a BMI lower than 25, and 199 (62.18%) patients had a BMI of 25 or higher. The 30-day mortality rate was 1.8% (n = 6) in the whole group; only 2 of these patients had a BMI of 25 or higher. Perioperative morbidity occurred in 28 (23.14%) of patients with a normal BMI and in 47 (23.61%) of patients with a BMI of 25 or higher (P = .54). Specific morbidities encountered by patients with normal versus BMI of 25 or higher were as follows: atrial fibrillation, 11 (9.09%) versus 24 (12.06%) (P = .46); pulmonary embolism, 1 (0.83%) versus 3 (1.51%) (P = 1.0); congestive heart failure, 2 (1.65%) versus 2 (1.01%) (P = .63); renal failure, 4 (3.3%) versus 2 (1.0%) (P = .29); respiratory failure, 12 (9.92%) versus 17 (8.54%) (P = .69); and acute respiratory distress syndrome, 2 (1.65%) versus 1 (0.50%) (P = .55). The median hospital stay was 5 days in the lower BMI group and 4 days in the BMI of 25 or higher group (P = .52). CONCLUSIONS Overweight and normal weight patients do not differ significantly in rates of perioperative morbidities, 30-day mortality, and length of stay. Our study indicates that potential curative surgical resections can be offered to even significantly overweight patients.
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Paleiron N, André M, Grassin F, Chouaïd C, Venissac N, Margery J, Couturaud F, Noël-Savina E, Tromeur C, Vinsonneau U, Vedrine L, Leroyer C, Nowak E, Berard H, Thomas P, Brouchet L, Bagan P, Fournel P, Mottier D, Robinet G. Évaluation de la ventilation non invasive préopératoire avant chirurgie de résection pulmonaire. Étude préOVNI GFPC 12-01. Rev Mal Respir 2013; 30:231-7. [DOI: 10.1016/j.rmr.2012.10.601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/29/2012] [Indexed: 11/26/2022]
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Rocco G, Gatani T, Di Maio M, Meoli I, La Rocca A, Martucci N, La Manna C, Stefanelli F. The impact of decreasing cutoff values for maximal oxygen consumption (VO(2)max) in the decision-making process for candidates to lung cancer surgery. J Thorac Dis 2013; 5:12-8. [PMID: 23372945 DOI: 10.3978/j.issn.2072-1439.2012.12.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/18/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Maximal oxygen consumption (VO(2)max) is considered a decisive test for risk prediction in patients with borderline cardiopulmonary reserve. Guidelines have adopted decreasing VO(2)max cut-off values to define operability within acceptable mortality and morbidity limits. We wanted to investigate how the adoption of decreasing VO(2)max cut-off-values assessment contributed to better select lung surgery candidates. METHODS One hundred and nineteen consecutive surgical candidates have been prospectively analyzed as a sample population. Preoperative work-up included spirometry and transfer factor (DLco); irrespective of the spirometric values, these patients were subjected to VO(2)max assessment. Surgical eligibility was decided by the same surgeon throughout the series. In the postoperative period, overall mortality and the occurrence of any, major or minor complications was recorded and graded according to the Common Terminology Criteria for Adverse Events v.4.3. RESULTS Three arbitrary cut-offs were introduced at 15, 14 and 12 mL(.)kg(-1) (.)min(-1). Notably, 15 and 12 mL(.)kg(-1) (.)min(-1) correlated with percentage VO(2)max values of 50% and 35% of predicted (P<0.0001 and 0.0079), respectively. Accordingly, the patients were subdivided into groups in which the prevalence of postoperative morbidity was recorded. The groups were homogeneous as to age, BMI, preoperative absolute and percentage FEV1 and DLco. In the Cox proportionate-hazards multivariate analysis, VO(2)max less than 35% (P=0.0017) and CTCAE >2 (P=0.0457) emerged as significant predictors of survival after surgery. Conversely on logistic regression analysis, age over 70 years (P=0.03) and pneumonectomy (P=0.001), but not VO(2)max cut-off values, were significant predictors of major (CTCAE >2) morbidity. CONCLUSIONS Since VO(2)max is increasingly used to contribute to risk prediction for the individual patient, surgeons need to be advised that the concept of a definitive, generalized cut-off value for VO(2)max is probably a contradiction in terms. Patient-specific VO(2)max values are more likely to contribute to risk assessment since they may reflect the primarily affected component among the determinants of maximal oxygen consumption. Whether patient-specific VO(2)max should be routinely used by surgeons to define operability for borderline patients needs further evaluation.
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Affiliation(s)
- Gaetano Rocco
- Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery and Service of Physiopathology, National Cancer Institute, Naples, Italy; ; Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy
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Abstract
It is well recognized that obesity contributes to multiple co-morbidities, and it would seem intuitive that obese patients experience an increase in post-operative complications after colorectal surgery. Overall, the data examining postoperative morbidity and mortality in the obese colorectal patient is inconsistent. Studies have shown a trend for obese patients have a higher post-operative risk of pulmonary embolism, atelectasis, cardiac complications, and thromboembolic disease. However, even with multiple large trials concluding this, there are also many studies showing no difference. The literature has shown that using laparoscopic techniques is safe and feasible, but there is a higher rate of conversion to open, and longer operative times. In addition, obese patients might have a higher leak rate for distal anastomosis as compared with normal weight patients. These patients also have a higher post-operative rate of stomal complications and fascial dehiscense. In reviewing the literature, at best, the complication rate in obese patients is the same as non-obese patients after colorectal surgery, but there are significant trends that suggest a negative effect of obesity after colorectal surgery.
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Affiliation(s)
- Timothy M Geiger
- Colon and Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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St Julien JB, Aldrich MC, Sheng S, Deppen SA, Burfeind WR, Putnam JB, Lambright ES, Nesbitt JC, Grogan EL. Obesity increases operating room time for lobectomy in the society of thoracic surgeons database. Ann Thorac Surg 2012; 94:1841-7. [PMID: 23040822 PMCID: PMC3748581 DOI: 10.1016/j.athoracsur.2012.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/26/2012] [Accepted: 08/01/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity has become a major epidemic in the United States. Although research suggests obesity does not increase major morbidity or mortality after thoracic operations, it likely results in greater use of health care resources. METHODS We examined all patients in The Society of Thoracic Surgeons General Thoracic Surgery database with primary lung cancer who underwent lobectomy from 2006 to 2010. We investigated the impact of body mass index (BMI) on total operating room time using a linear mixed-effects regression model and multiple imputations to account for missing data. Secondary outcomes included postoperative length of stay and 30-day mortality. Covariates included age, sex, race, forced expiratory volume, smoking status, Zubrod score, prior chemotherapy or radiation, steroid use, number of comorbidities, surgical approach, hospital lobectomy volume, hospital percent obesity, and the addition of mediastinoscopy or wedge resection. RESULTS A total of 19,337 patients were included. The mean BMI was 27.3 kg/m2, with 4,898 patients (25.3%) having a BMI of 30 kg/m2 or greater. The mean total operating room time, length of stay, and 30-day mortality were 240 minutes, 6.7 days, and 1.8%, respectively. For every 10-unit increase in BMI, mean operating room time increased by 7.2 minutes (range, 4.8 to 8.4 minutes; p<0.0001). Higher hospital lobectomy volume and hospital percentage of obese patients did not affect the association between BMI and operative time. Body mass index was not associated with 30-day mortality or increased length of stay. CONCLUSIONS Increased BMI is associated with increased total operating room time, regardless of institutional experience with obese patients.
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Affiliation(s)
- Jamii B St Julien
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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[Preoperative risk evaluation of adult patients for elective, noncardiac surgical interventions. Results of an on-line survey on the status in Germany]. Anaesthesist 2012; 61:407-19. [PMID: 22576992 DOI: 10.1007/s00101-012-2019-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND While assessing the medical history and physical examination are the cornerstones of preoperative risk evaluation, the importance of "routine" testing has been critically discussed in recent studies. The joint recommendations of the German Societies of Anaesthesiology and Intensive Care Medicine, Surgery and Internal Medicine for preoperative evaluation of adult patients prior to elective, non-cardiac surgery, which were published in November 2010, are the first comprehensive practice guidelines for preoperative evaluation in Germany. Aim of this study was to analyze former strategies for assessing perioperative risk at anaesthesia departments in Germany. METHODS A 29-item questionnaire concerning general hospital characteristics, strategies for preoperative evaluation and cognizance of the joint recommendations was developed as an online survey. In particular the reasons for technical assessment were surveyed (i.e. routine, patient age or pre-existing conditions, risk of operation being performed). In certain questions multiple answers were permitted. All hospitals with departments of anaesthesiology in Germany were included. Data are presented as percentages. RESULTS A total of 396 hospitals (35.6%) completed the questionnaire. Physical examination is not performed regularly (37%) but only when indicated by the medical history. Criteria for performing preoperative electrocardiograms are comorbidities of the cardiovascular (80.1%) and pulmonary systems (42.2%) as well as patient age (52.8%) and as routine measures (10.1%). Laboratory testing was performed as a routine (43.2%) because of patient age (52.8%) or pre-existing conditions (37.3%). Preoperative chest x-ray was carried out when the medical history or physical examination suggest intrathoracic pathologies (81.3%) or was based on patient age (35.9%). The majority of hospitals (89.1%) plan to implement the joint recommendations for preoperative evaluation in the future. CONCLUSION According to the joint recommendations preoperative testing is more and more directed to patients with an increased perioperative risk which is clinically indicated by medical history and physical examination. However, routine or age-related medical testing is still a frequently used strategy. German medical societies should focus on advanced implementation strategies to change current practices in order to avoid unnecessary diagnostic procedures and to increase patient safety and satisfaction.
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Petrella F, Rizzo S, Radice D, Borri A, Galetta D, Gasparri R, Solli P, Veronesi G, Bellomi M, Spaggiari L. Predicting prolonged air leak after standard pulmonary lobectomy: Computed tomography assessment and risk factors stratification. Surgeon 2011; 9:72-7. [DOI: 10.1016/j.surge.2010.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/18/2010] [Accepted: 07/19/2010] [Indexed: 11/16/2022]
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Petrella F, Radice D, Borri A, Galetta D, Gasparri R, Solli P, Veronesi G, Spaggiari L. 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 2010; 39:738-44. [PMID: 20952203 DOI: 10.1016/j.ejcts.2010.09.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 09/02/2010] [Accepted: 09/05/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Although it may seem intuitive that obesity is an additional risk factor for surgical patients, few studies have correlated this condition with lung cancer resection. The only data currently available suggest that obesity does not increase the rate of complications after anatomic resection for non-small-cell lung cancer (NSCLC). METHODS We enrolled 154 consecutive patients undergoing standard pneumonectomy for NSCLC at the Department of Thoracic Surgery of the European Institute of Oncology from January 2004 to April 2008. To determine the influence of preoperative body mass index (BMI) on postoperative complications, patients were classified into two groups: (1) BMI ≥ 25 kg m⁻²; n = 93 (60.4%); and (2) BMI < 25 kg m⁻²; n = 61 (39.6%). Data on sex, age, cigarette smoking, preoperative albumin, total proteins and creatinine values, forced expiratory volume in 1s percentage (FEV1%), diffusion lung capacity for carbon monoxide/alveolar volume percentage (DLCO/AV%) and histology and pathological stage were collected. Information on total postoperative complications, 30-day mortality rate, specific pulmonary and cardiac complications, intensive care unit (ICU) admission and hospital stay was collected and analysed for the BMI group. RESULTS Among the 154 operated patients, 30 (19.5%) were women with a mean age of 63.4 years (range: 36-82). As many as 136 (88.3%) patients were smokers or former smokers; 80 patients (51.9%) received presurgical treatment. A total of 64 (41.6%) right pneumonectomy procedures were performed. Mean ± SD for preoperative variables were FEV1%: 83.5 ± 19.2, DLCO/AV: 85.4% ± 20.3, albumin: 4.07 ± 0.44 g dl(-1), total proteins: 7.23 ± 0.59 g dl⁻¹, creatinine: 0.81 ± 0.23 mg dl⁻¹. Ten patients died within the first 30 days (30-day mortality: 6.5%). The male sex was significantly more prevalent in the high BMI group (p=0.039). The preoperative mean creatinine value was significantly higher in the high BMI group (0.86 mg dl(-1) vs 0.75 mg dl⁻¹, p=0.002) and preoperative DLCO/AV values were better in the high BMI group than in the BMI group < 25 kg m⁻² (79.9 vs 88.8, p = 0.009). The high BMI group had a higher incidence of respiratory complications (21.5% vs 4.9% p = 0.005, odds ratio (OR) = 5.3, 95% confidence interval (CI): 1.5, 18.7). No significant differences were observed between the two groups regarding ICU admission, hospital stay, 30-day mortality and total and specific cardiac complications. CONCLUSIONS The risk of respiratory complications in patients with BMI higher than 25 kg m⁻² undergoing pneumonectomy for lung cancer is 5.3 times higher than that of patients with BMI < 25 kg m⁻². Thoracic surgeons and anaesthesiologists should be aware of this information before planning elective pneumonectomy in overweight and especially in obese patients.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol 2010. [DOI: 10.1016/j.jgo.2010.06.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kozower BD, Sheng S, O'Brien SM, Liptay MJ, Lau CL, Jones DR, Shahian DM, Wright CD. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg 2010; 90:875-81; discussion 881-3. [PMID: 20732512 DOI: 10.1016/j.athoracsur.2010.03.115] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/16/2010] [Accepted: 03/19/2010] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of this study is to create models for perioperative risk of lung cancer resection using the STS GTDB (Society of Thoracic Surgeons General Thoracic Database). METHODS The STS GTDB was queried for all patients treated with resection for primary lung cancer between January 1, 2002 and June 30, 2008. Three separate multivariable risk models were constructed (mortality, major morbidity, and composite mortality or major morbidity). RESULTS There were 18,800 lung cancer resections performed at 111 participating centers. Perioperative mortality was 413 of 18,800 (2.2%). Composite major morbidity or mortality occurred in 1,612 patients (8.6%). Predictors of mortality include the following: pneumonectomy (p < 0.001), bilobectomy (p < 0.001), American Society of Anesthesiology rating (p < 0.018), Zubrod performance status (p < 0.001), renal dysfunction (p = 0.001), induction chemoradiation therapy (p = 0.01), steroids (p = 0.002), age (p < 0.001), urgent procedures (p = 0.015), male gender (p = 0.013), forced expiratory volume in one second (p < 0.001), and body mass index (p = 0.015). CONCLUSIONS Thoracic surgeons participating in the STS GTDB perform lung cancer resections with a low mortality and morbidity. The risk-adjustment models created have excellent performance characteristics and identify important predictors of mortality and major morbidity for lung cancer resections. These models may be used to inform clinical decisions and to compare risk-adjusted outcomes for quality improvement purposes.
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Affiliation(s)
- Benjamin D Kozower
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908-0679, USA.
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Postoperative care after pulmonary resection: postanesthesia care unit versus intensive care unit. Curr Opin Anaesthesiol 2009; 22:50-5. [PMID: 19295292 DOI: 10.1097/aco.0b013e32831d7b25] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW In an effort to maximize resource utilization and contain costs, immediate postoperative care after noncardiac thoracic surgery is often done in either the postanesthesia care unit or dedicated step down units, leaving the ICU for complex surgical cases, overtly high-risk patients, or the treatment of severe postoperative complications. This review analyzes the current modalities affecting length of stay and costs, mainly by allocating patients after elective lung resection to different postoperative areas according to their needs. RECENT FINDINGS Several surgical models have been published in recent years with the goal of optimizing perioperative patient care and subsequently decreasing hospital costs and length of stay. The main focus has been on elective lung resection for lung cancer. Preoperative evaluation, changes in surgical and anesthetic techniques as well as careful planning on where to recover these patients seem to make a clinical and financial impact. SUMMARY The development of models to help predict elective ICU admission should facilitate optimal care, cutting costs and shortening length of stay after lung resection.
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Impact of obesity on perioperative outcomes of minimally invasive esophagectomy. Ann Thorac Surg 2009; 87:412-5. [PMID: 19161748 DOI: 10.1016/j.athoracsur.2008.10.072] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 10/21/2008] [Accepted: 10/23/2008] [Indexed: 01/01/2023]
Abstract
BACKGROUND Abnormal body mass index has been targeted as a predictor of complications after major surgery. The aim of this study was to review the impact of obesity on perioperative outcomes after minimally invasive esophagectomy. METHODS This study was a single-institution retrospective review of patients undergoing minimally invasive esophagectomy for high-grade dysplasia or cancer of the esophagus between 1999 and 2004. A body mass index of 30 or greater was considered obese. Patients with a body mass index less than 18.5 were excluded because of the potentially adverse effects of malnutrition on outcomes. RESULTS A total of 282 eligible patients were identified. There were 84 obese and 198 nonobese patients (mean body mass index = 34.5 versus 25.5; p < 0.0001). Preoperative demographics, comorbidities, and cancer status were similar, except for a higher prevalence of diabetes (p = 0.002), lower prevalence of peripheral vascular disease (p = 0.045), and lower prevalence of stage III disease in the obese group (p = 0.044). Operative time was significantly longer in obese patients (375 versus 301 minutes; p = 0.0001), and estimated blood loss was similar (433 versus 377 mL, obese versus nonobese, respectively). There were 5 (1.8%) overall 30-day perioperative mortalities, with no differences between the groups. Overall major (obese, 23 [27.5%] versus nonobese, 68 [34.3%]) and minor (obese, 23 [27.5%] versus nonobese, 65 [32.8%]) complication rates were also similar. Furthermore, there were no significant differences in any individual complications. There was no difference in median intensive care unit stay (obese, 1 day versus nonobese, 2 days) or overall hospital stay (obese, 7 days versus nonobese, 8 days). CONCLUSIONS Obesity was associated with longer operative times. Our review suggests that obesity is not a risk factor for mortality, postoperative complications, or length of hospitalization after minimally invasive esophagectomy.
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Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer. Surg Today 2009; 39:104-9. [PMID: 19198986 DOI: 10.1007/s00595-008-3821-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 05/12/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Clinical pathways have contributed to standardized postoperative management, but analyzing variance is also important to maintain quality control. To evaluate the validity of our own clinical pathway for managing video-assisted lobectomy for lung cancer, we analyzed the variances influencing postoperative recovery. METHODS Between April 2003 and April 2004, 62 consecutive patients with lung cancer underwent video-assisted single anatomic lobectomy with lymph node dissection. We evaluated 61 of these patients after the exclusion of one, who deviated from the clinical pathway management immediately as a result of serious complications. RESULTS There were 29 men and 32 women, with an average age of 65.7 years. Complications developed in 29 patients, but there was no operative mortality. The occurrence of variance ranged from 1.6% to 34.4% for each activity and included prolonged supplemental oxygen therapy, out-of routine examination, prolonged epidural anesthesia, and delayed bathing frequently. Complications and an abnormal body mass index were significant and independent clinical factors affecting the increase in variance. CONCLUSIONS Our original clinical pathway management was tolerable for lung cancer patients undergoing a video-assisted lobectomy. Complications and an abnormal body mass index were significant predictive factors for an increase in variance of our clinical pathway.
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Bernstein WK, Deshpande S. Preoperative evaluation for thoracic surgery. Semin Cardiothorac Vasc Anesth 2009; 12:109-21. [PMID: 18635562 DOI: 10.1177/1089253208319868] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of the preoperative evaluation for thoracic surgery is to assess and implement measures to decrease perioperative complications and prepare high-risk patients for surgery. Major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, occur in 15% to 20% of patients and account for most of the 3% to 4% mortality rate. Development of pulmonary complications has been associated with higher postoperative mortality rates. Strategies aimed at preventing postoperative difficulties have the potential to reduce morbidity and mortality, decrease hospital stay, and improve resource use. One lung ventilation leads to a significant derangement of gas exchange, and hypoxemia can develop due to increased intrapulmonary shunting. Recent advances in anesthetic management, monitoring devices, improved lung isolation techniques, and improved critical care management have increased the number of patients who were previously considered inoperable. In addition, there is a growing tendency to offer surgery to patients with significant lung function impairment; hence a higher incidence of intraoperative gas-exchange abnormalities can be expected. The anesthesiologist must also consider the risks of denying or postponing a potentially curative operation in patients with lung cancer. Detailed consideration of the information provided by preoperative testing is essential to successful outcomes following thoracic surgery.
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Affiliation(s)
- Wendy K Bernstein
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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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; 16:463-7. [DOI: 10.1177/021849230801600607] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obesity is perceived as a risk factor in general thoracic surgery. We conducted a single-center retrospective evaluation of perioperative complications in 822 patients who underwent thoracic surgery between 2000 and 2005. According to body mass index, 82 were underweight (< 18.5 kg·m−2), 568 were normal (18.5–24.9 kg·m−2), 155 were overweight (25.0–29.9 kg·m−2), and 17 were obese (≥30 kg·m−2). A significant increase in preoperative comorbidity (hypertension and ischemic heart disease) was observed with increasing body mass index. There was no significant difference in operation time or length of stay in the operating room, but extubation time was significantly different among the 4 groups. Of the intraoperative complications, alveolar-arterial oxygen difference increased significantly with increasing obesity, and hypoxia was least common in the normal group. Postoperatively, there was more pulmonary leakage in the underweight group and less pneumonia in the normal group. Both the underweight and the obese are at increased risk of perioperative complications and need to be carefully observed and managed intraoperatively and postoperatively.
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Affiliation(s)
| | - Taro Sakoguchi
- Department of Anesthesiology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center Fukuoka, Japan
| | - Keiko Morikawa
- Department of Anesthesiology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center Fukuoka, Japan
| | | | - Hiroyuki Tanaka
- Department of Anesthesiology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center Fukuoka, Japan
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