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Inicio Cirugía Española (English Edition) “Obesity paradox” has not an impact on minimally invasive anatomical lung re...
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Vol. 100. Issue 5.
Pages 288-294 (May 2022)
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Vol. 100. Issue 5.
Pages 288-294 (May 2022)
Original article
“Obesity paradox” has not an impact on minimally invasive anatomical lung resection
La «paradoja de la obesidad» no tiene impacto en las resecciones pulmonares anatómicas mínimamente invasivas
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María Teresa Gómez-Hernándeza,
Corresponding author
mtgh@usal.es

Corresponding author.
, Marta G Fuentesa, Nuria M Novoaa, Israel Rodrígueza, Gonzalo Varelab, Marcelo F Jiméneza,b
a Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
b Salamanca Institute of Biomedical Research (IBSAL), Spain
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Tables (6)
Table 1. Characteristics of the patients included in the analysis.
Table 2. Association of BMI and overall morbidity after minimally invasive (VATS/RATS) major lung resection.
Table 3. Association of BMI and respiratory complications after minimally invasive (VATS/RATS) major lung resection.
Table 4. Association of BMI and cardiovascular complications after minimally invasive (VATS/RATS) major lung resection.
Table 5. Association of BMI and surgical complications after minimally invasive (VATS/RATS) major lung resection.
Table 6. Influence of metabolic syndrome related comorbidities on postoperative complications after minimally invasive (VATS/RATS) major lung resection in patients with BMI≥30kg/m2.
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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 BMI30kg/m2 and BMI35kg/m2 is 4.5 and 6 times higher than that of patients with normal BMI.

Keywords:
Lung resection
Obesity paradox
Minimally invasive surgery
Robotics
Postoperative complications
Resumen
Introducción

El beneficio paradójico de la obesidad, la «paradoja de la obesidad», ha sido analizado en distintas series de cirugía de resección pulmonar con conclusiones contradictorias. El objetivo del estudio es evaluar la influencia del índice de masa corporal (IMC) en los resultados postoperatorios de resecciones pulmonares anatómicas por vía mínimamente invasiva.

Métodos

Revisión retrospectiva de pacientes consecutivos sometidos a resección pulmonar anatómica a través de un abordaje mínimamente invasivo durante el período comprendido entre 2014 y 2019. Los pacientes se agruparon en: bajo peso, normopeso, sobrepeso y obesidad tipo I, II y III. Se calcularon las odds ratio ajustadas con respecto a las distintas complicaciones (globales, respiratorias, cardiovasculares y quirúrgicas) con sus intervalos de confianza al 95% (IC 95%). Todas las pruebas se consideraron estadísticamente significativas con p<0,05.

Resultados

Entre 722 pacientes incluidos en el estudio, el 37,7% tenían un IMC normal y el 61,8% eran pacientes con sobrepeso u obesidad. En comparación con los pacientes con IMC normal, las complicaciones pulmonares ajustadas fueron significativamente mayores en los pacientes obesos tipo I (2,6 vs. 10,6%; OR: 4,53 [IC 95%: 1,72-11,92]) y obesos tipo II-III (2,6 vs. 10%; OR: 6,09 [IC 95%: 1,38-26,89]). No se encontraron diferencias significativas con respecto a las complicaciones globales, cardiovasculares o quirúrgicas entre los distintos grupos.

Conclusiones

La obesidad no tiene efectos favorables en los resultados postoperatorios en pacientes sometidos a resecciones pulmonares anatómicas mínimamente invasivas. El riesgo de complicaciones respiratorias en pacientes con IMC30kg/m2 e IMC35kg/m2 es 4,5 y 6 veces mayor que el de pacientes con IMC normal.

Palabras clave:
Resección pulmonar
Paradoja de la obesidad
Cirugía mínimamente invasiva
Robótica
Complicaciones postoperatorias

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