Obesity Increases Operating Room Time for Lobectomy in The Society of Thoracic Surgeons Database

Abstract

Background Obesity has become a major epidemic in the US. Though research suggests obesity does not increase major morbidity or mortality after thoracic operations, it likely results in greater use of healthcare 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 imputation to account for missing data. Secondary outcomes included postoperative length of stay and 30-day mortality. Covariates included age, gender, 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 ≥ 30 kg/m2. 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 (4.8 – 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. BMI was not associated with 30-day mortality or increased length of stay. Conclusions Increased body mass index is associated with increased total operating room time, regardless of institutional experience with obese patients.

Association of body mass index and outcomes after major lung resection

“…Obesity is associated with increased operating time [1], but whether obesity is associated with increased risk is uncertain based on recent clinical reports [2][3][4][5]. In contrast, little information has been published on the association of low BMI and outcomes after major lung resection.…”

“…Surgeons traditionally welcome the easily discerned internal anatomy of thin patients, while reluctantly facing challenges that obese patients present. The greater technical and physical demands engendered by substantial girth and excess mediastinal fat are associated with increased operating time for major lung resection [1]. Obesity intuitively increases the perioperative risks of lung surgery owing to associated comorbidities such as diabetes, hypertension and coronary artery disease, and physiological impairment of ventilation.…”

Does obesity affect the outcomes of pulmonary resections for lung cancer? A National Surgical Quality Improvement Program analysis

“…Several single-center series described no BMI-related differences in outcomes, whereas other authors reported that pulmonary resections for lung cancer in obese patients are associated with a greater incidence of adverse perioperative events, such as respiratory complications or prolonged operative time. [5][6][7][8] The use of a large national database has the potential to yield a more meaningful perspective on the topic by providing complementary information to previously reported studies. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to analyze the effects of obesity on the early operative outcomes of pulmonary resections for lung cancer.…”

Obésité et cancer bronchique : incidences épidémiologiques, pathologiques et thérapeutiques

“…Cela a été rapporté en orthopédie, en urologie et en chirurgie générale, et a également été observé en chirurgie thoracique. Dans la base de données nationale de la société américaine de chirurgie thoracique, 19 337 patients ont eu une lobectomie pour cancer [39]. L'IMC moyen était de 27,3 kg/m 2 .…”

“…Cette augmentation de durée était indépendante du volume d'activité de l'institution et de l'expérience des chirurgiens. Par contre, ni le taux de mortalité postopératoire ni la durée de l'hospitalisation n'étaient augmentés du fait de l'obésité [39].…”