Background Body mass index (BMI) has been shown to be an independent predictor of survival following lung resection surgery. This study aimed to quantify the short- to midterm impact of abnormal BMI on postoperative outcomes. Methods Lung resections at a single institution were examined between 2012 and 2021. Patients were divided into low BMI (<18.5), normal/high BMI (18.5–29.9), and obese BMI (>30). Postoperative complications, length of stay, and 30- and 90-day mortality were examined. Results A total of 2,424 patients were identified. Of these patients, 2.6% (n = 62) had a low BMI, 67.4% (n = 1,634) had a normal/high BMI, and 30.0% (n = 728) had an obese BMI. Overall postoperative complications were higher in the low BMI group (43.5%) when compared with normal/high (30.9%) and obese BMI group (24.3%) (p = 0.0002). Median length of stay was significantly higher in the low BMI group (8.3 days) compared with 5.2 days in the normal/high and obese BMI groups (p < 0.0001). Ninety-day mortality was higher in the low (16.1%) compared with the normal/high (4.5%) and obese BMI groups (3.7%) (p = 0.0006). Subgroup analysis of the obese cohort did not elucidate any statistically significant differences in overall complications in the morbidly obese. Multivariate analysis determined that BMI is an independent predictor of reduced postoperative complications (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94–0.97; p < 0.0001) and 90-day mortality (OR, 0.96; 95% CI, 0.92–0.99; p = 0.02). Conclusion Low BMI is associated with significantly worse postoperative outcomes and an approximate fourfold increase in mortality. In our cohort, obesity is associated with reduced morbidity and mortality following lung resection surgery, confirming the existence of the obesity paradox.

中文翻译：

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极端体重指数对肺切除术后结果的影响

背景 体重指数（BMI）已被证明是肺切除手术后生存的独立预测因子。本研究旨在量化体重指数异常对术后结果的短期至中期影响。方法 对2012年至2021年间单一机构的肺切除手术进行检查。患者分为低BMI（<18.5）、正常/高BMI（18.5-29.9）和肥胖BMI（>30）。检查术后并发症、住院时间以及 30 天和 90 天死亡率。结果 总共识别出 2,424 名患者。在这些患者中，2.6% (n = 62) 的 BMI 较低，67.4% (n = 1,634) 的 BMI 正常/较高，30.0% (n = 728) 的 BMI 肥胖。与正常/高 BMI 组 (30.9%) 和肥胖 BMI 组 (24.3%) 相比，低 BMI 组 (43.5%) 的总体术后并发症较高 (p = 0.0002)。低 BMI 组的中位住院时间（8.3 天）显着高于正常/高和肥胖 BMI 组的 5.2 天（p < 0.0001）。与正常/高 BMI 组 (4.5%) 和肥胖 BMI 组 (3.7%) 相比，低 BMI 组 (16.1%) 的 90 天死亡率较高 (p = 0.0006)。肥胖队列的亚组分析并未阐明病态肥胖者总体并发症的任何统计学显着差异。多变量分析确定，BMI 是减少术后并发症（比值比 [OR]，0.96；95% 置信区间 [CI]，0.94–0.97；p < 0.0001）和 90 天死亡率（OR，0.96；95%）的独立预测因子CI，0.92–0.99；p = 0.02）。结论 低 BMI 与术后结果明显较差以及死亡率增加约四倍相关。在我们的队列中，肥胖与肺切除手术后发病率和死亡率的降低相关，证实了肥胖悖论的存在。