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. 2023 Spring;35(1):164-176.
doi: 10.1053/j.semtcvs.2022.02.004. Epub 2022 Feb 17.

The Overweight Paradox: Impact of Body Mass Index on Patients Undergoing VATS Lobectomy or Segmentectomy

Sara Parini  1 , Danila Azzolina  2 , Fabio Massera  3 , Maria Giovanna Mastromarino  3 , Esther Papalia  3 , Guido Baietto  3 , Carlo Curcio  4 , Roberto Crisci  5 , Ottavio Rena  6 ; Italian VATS Group; Marco Alloisio  7 , Dario Amore  4 , Luca Ampollini  8 , Nicoletta Ardò  9 , Desideria Argnani  10 , Alessandro Baisi  11 , Alessandro Bandiera  12 , Cristiano Benato  13 , Mauro Roberto Benvenuti  14 , Alessandro Bertani  15 , Luigi Bortolotti  16 , Edoardo Bottoni  7 , Cristiano Breda  17 , Pierpaolo Camplese  18 , Paolo Carbognani  8 , Giuseppe Cardillo  19 , Francesco Carleo  19 , Giorgio Cavallesco  20 , Roberto Cherchi  21 , Angela De Palma  22 , Andrea Dell'Amore  23 , Vittorio Della Beffa  24 , Duilio Divisi  5 , Giampiero Dolci  25 , Andrea Droghetti  26 , Paolo Ferrari  21 , Diego Fontana  24 , Roberto Gasparri  27 , Diego Gavezzoli  14 , Marco Ghisalberti  28 , Michele Giovanardi  26 , Alessandro Gonfiotti  29 , Francesco Guerrera  30 , Andrea Imperatori  31 , Maurizio Infante  13 , Paolo Lausi  30 , Fabio Lo Giudice  17 , Francesco Londero  32 , Camillo Lopez  33 , Maurizio Mancuso  34 , Pio Maniscalco  20 , Stefano Margaritora  35 , Giuseppe Marulli  22 , Federico Mazza  36 , Elisa Meacci  35 , Giulio Melloni  36 , Angelo Morelli  32 , Felice Mucilli  18 , Pamela Natali  37 , Giampiero Negri  12 , Samuele Nicotra  23 , Mario Nosotti  38 , Piero Paladini  28 , Gianluca Pariscenti  39 , Reinhold Perkmann  40 , Fausto Pernazza  34 , Emanuele Pirondini  41 , Francesco Puma  42 , Federico Raveglia  11 , Majed Refai  43 , Alessandro Rinaldo  44 , Carlo Risso  39 , Giovanna Rizzardi  16 , Nicola Rotolo  31 , Marco Scarci  41 , Piergiorgio Solli  25 , Francesco Sollitto  9 , Lorenzo Spaggiari  27 , Alessandro Stefani  37 , Franco Stella  10 , Corrado Surrente  33 , Giorgia Tancredi  15 , Alberto Terzi  45 , Massimo Torre  44 , Davide Tosi  38 , Damiano Vinci  42 , Andrea Viti  45 , Luca Voltolini  29 , Francesco Zaraca  40
Affiliations

The Overweight Paradox: Impact of Body Mass Index on Patients Undergoing VATS Lobectomy or Segmentectomy

Sara Parini et al. Semin Thorac Cardiovasc Surg. 2023 Spring.

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.

Keywords: Body Mass Index (BMI); Lung resection; Obesity paradox; Overweight paradox; Thoracic surgery; VATS.

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