Impact of Obesity on Postoperative Morbidity after Pneumonectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Nan , JIANG Gening , WANG Haifeng , LIU Ming , HE Wenxin , ZHANG Peng , DING Jiaan.

Department of Thoracic Surgery， Shanghai Pulmonary Hospital， School of Medicine of Tongji University， Shanghai 200433， P. R. China;

Corresponding author：

Keywords：

Pneumonectomy; 　Obesity; 　Postoperative morbidity; 　Mortality

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Abstract： Objective To explore the impact of obesity on postoperative morbidity and mortality after pneumonectomy. Methods Clinical data of 3 494 patients with pulmonary diseases who underwent pneumonectomy in Shanghai Pulmonary Hospital from September 2003 to December 2007 were retrospectively analyzed. All the 3 494 patients were divided into two groups according to the patients’ preoperative body mass index （BMI）. There were 3 340 patients in the non-obesity group （BMI＜28 kg/m2） including 2 502 males and 838 females with their average age of 61.9±10.7 years， and 154 patients in the obesity group （BMI≥28 kg/m2） including 87 males and 67 females with their average age of 59.7±9.6 years. Univariate analysis and logistic regression were used to analyze the impact of obesity （BMI≥28 kg/m2） on postoperative morbidity after pneumonectomy. Results There were a total of 26 cases of perioperative death， including　23 patients in the non-obesity group and 3 patients in the obesity group. There was no statistical difference in mortality between the two groups ［0.7% （23/3 340） vs. 1.9% （3/154）， P=0.118］. There was no statistical difference in any particular postoperative morbidity or incidence of pulmonary complications between the two groups （P＞0.05）. Other than pulmonary complications， the incidence of postoperative complication in other body systems of the obesity group was significant higher than that of the non-obesity group （P＜0.05）. The incidence of cerebrovascular accidents， myocardial infarction and acute renal failure of the obesity group was significant higher than those of the non-obesity group （P＜0.05）. Logistic　regression showed that obesity （BMI≥28 kg/m2） was not an independent risk factor for postoperative morbidity after pneumonectomy ［B=0.648， OR=1.911， 95% CI（0.711， 5.138），P=0.199］. Conclusion Obesity is not a significant risk factor of postoperative mortality or morbidity after pneumonectomy.

Citation： SONG Nan,JIANG Gening,WANG Haifeng,LIU Ming,HE Wenxin,ZHANG Peng,DING Jiaan.. Impact of Obesity on Postoperative Morbidity after Pneumonectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 74-78. doi: Copy

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1. 　中华人民共和国疾病控制司. 中国成人超重和肥胖症预防控制指南. 2003. 2.
2. 　赵文华，翟屹，胡建平，等. 中国超重和肥胖造成相关慢性疾病的经济负担研究. 中华流行病学杂志， 2006， 27 （7）：555-559.
3. 　雷艺炎，陈振光，罗红鹤，等. 肺癌患者围术期并发症发生的危险因素分析. 中国胸心血管外科临床杂志， 2008， 15 （4）：268-271.
4. 　王邵华，阮征，郑健，等. 肺切除术后肺部并发症发生的危险因素分析. 中国胸心血管外科临床杂志， 2010， 17 （4）：301-306.
5. 　马柱，李德生，阿不都艾尼?吐尔洪，等. 生理学和手术侵袭度评分在肺癌手术风险预测中的应用. 中国胸心血管外科临床杂志， 2012， 19 （1）：31-35.
6. 　Myrdal G， Gustafsson G， Lambe M， et al. Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity. Eur J Cardiothorac Surg， 2001， 20 （4）：694-699.
7. 　Kalathiya RJ， Saha SP. Pneumonectomy for non-small cell lung Cancer：outcomes analysis. South Med J， 2012， 105 （7）：350-354.
8. 　Menna C， Ciccone AM， Ibrahim M， et al. Pneumonectomy：quality of life and long-term results. Minerva Chir， 2012， 67 （3）：219-226.
9. 　Licker M， Spiliopoulos A， Frey JG， et al. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest， 2002， 121 （6）：1890-1897.
10. 　Kanasky WF Jr， Anton SD， Rodrigue JR， et al. Impact of body weight on long-term survival after lung transplantation. Chest， 2002， 121 （2）：401-406.
11. 　Heuer M， Kaiser GM， Kahraman A， et al. Liver transplantation in nonalcoholic steatohepatitis is associated with high mortality　 and post-transplant complications：a single-center experience.　 Digestion， 2012， 86 （2）：107-113.
12. 　Lascano CA， Kaidar-Person O， Szomstein S， et al. Challenges of laparoscopic colectomy in the obese patient：a review. Am J Surg， 2006， 192 （3）：357-365.
13. 　Porter SE， Russell GV， Dews RC， et al. Complications of acetabular fracture surgery in morbidly obese patients. J Orthop Trauma， 2008， 22 （9）：589-594.
14. 　李世宽，周岩冰，周成富，等. 肥胖对胃癌患者术后短期结局的影响. 中华胃肠外科杂志， 2010， 13 （2）：133-137.
15. 　Cooper L.Postoperative complications after thoracic surgery in the morbidly obese patient. Anesthesiol Res Pract， 2011， 865634.
16. 　Piestrzeniewicz K， Luczak K， Komorowski J， et al. The relationship between leptin and obesity and cardiovascular risk factors in men with acute myocardial infarction. Cardiol J， 2007， 14 （3）：252-259.
17. 　Flegal KM， Carroll MD， Ogden CL， et al. Prevalence and trends in obesity among US adults， 1999-2000. JAMA， 2002， 288 （14）：1723-1727.
18. 　Baskin ML， Ard J， Franklin F， et al. Prevalence of obesity in the United States. Obes Rev， 2005， 6 （1）：5-7.
19. 　Wang Y， Beydoun MA.The obesity epidemic in the United States-gender， age， socioeconomic， racial/ethnic， and geographic characteristics：a systematic review and meta-regression analysis. Epidemiol Rev， 2007， 29：6-28.
20. 　Bruce W， Van der Wall H， Peters M， et al. Occurrence of pulmonary thromboembolism immediately after arthroplasty. Nucl Med Commun， 2001， 22 （11）：1237-1242.
21. 　Ouellette DW， Patocka C. Pulmonary embolism. Emerg Med Clin North Am， 2012， 30 （2）：329-375.
22. 　Goldhaber SZ， Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet， 2012， 379 （9828）：1835-1846.
23. 　Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol， 2007， 44 （2）：62-69.
24. 　Gargiulo NJ 3rd， Veith FJ， Lipsitz EC， et al. Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures. J Vasc Surg， 2006， 44 （6）：1301-1305.
25. 　Karunakar MA， Shah SN， Jerabek S. Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am， 2005， 87 （7）：1498-1502.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of Obesity on Postoperative Morbidity after Pneumonectomy

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