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.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
BMI (Body Mass Index), VATS (Video-Assisted Thoracic Surgery), DFS (Disease Free Survival), OS (Overall Survival), WHO (World Health Organization), IRB (Institutional Review Board), FEV1 (Forced Expiratory Volume in the 1st second), FVC (Forced Vital Capacity), DLCO/Va (diffusing capacity of the lungs for carbon monoxide/ alveolar volume), IQR (Interquartile Range), OR (Odds Ratio), COPD (chronic obstructive pulmonary disease), DM (diabetes mellitus)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 16, 2022
Footnotes
IRB number: AOU Maggiore della Carità di Novara Institutional Review Board (approval number, CE 194/20), Aug 6, 2020. The IRB waived the need for informed written consent for publication.
Funding: the authors received no financial support for the research, authorship, or publication of this article.
Conflicts of Interest: the authors have no conflict of interest to declare.
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