Parini Sara, Azzolina Danila, Massera Fabio, Mastromarino Maria Giovanna, Papalia Esther, Baietto Guido, Curcio Carlo, Crisci Roberto, Rena Ottavio, Alloisio Marco, Amore Dario, Ampollini Luca, Ardò Nicoletta, Argnani Desideria, Baisi Alessandro, Bandiera Alessandro, Benato Cristiano, Benvenuti Mauro Roberto, Bertani Alessandro, Bortolotti Luigi, Bottoni Edoardo, Breda Cristiano, Camplese Pierpaolo, Carbognani Paolo, Cardillo Giuseppe, Carleo Francesco, Cavallesco Giorgio, Cherchi Roberto, De Palma Angela, Dell'Amore Andrea, Della Beffa Vittorio, Divisi Duilio, Dolci Giampiero, Droghetti Andrea, Ferrari Paolo, Fontana Diego, Gasparri Roberto, Gavezzoli Diego, Ghisalberti Marco, Giovanardi Michele, Gonfiotti Alessandro, Guerrera Francesco, Imperatori Andrea, Infante Maurizio, Lausi Paolo, Lo Giudice Fabio, Londero Francesco, Lopez Camillo, Mancuso Maurizio, Maniscalco Pio, Margaritora Stefano, Marulli Giuseppe, Mazza Federico, Meacci Elisa, Melloni Giulio, Morelli Angelo, Mucilli Felice, Natali Pamela, Negri Giampiero, Nicotra Samuele, Nosotti Mario, Paladini Piero, Pariscenti Gianluca, Perkmann Reinhold, Pernazza Fausto, Pirondini Emanuele, Puma Francesco, Raveglia Federico, Refai Majed, Rinaldo Alessandro, Risso Carlo, Rizzardi Giovanna, Rotolo Nicola, Scarci Marco, Solli Piergiorgio, Sollitto Francesco, Spaggiari Lorenzo, Stefani Alessandro, Stella Franco, Surrente Corrado, Tancredi Giorgia, Terzi Alberto, Torre Massimo, Tosi Davide, Vinci Damiano, Viti Andrea, Voltolini Luca, Zaraca Francesco
Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy; Università degli Studi di Torino, Turin, Italy.
Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Semin Thorac Cardiovasc Surg. 2023 Spring;35(1):164-176. doi: 10.1053/j.semtcvs.2022.02.004. Epub 2022 Feb 17.
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/m) 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.
本研究的目的是评估体重指数（BMI）对接受电视辅助胸腔镜肺叶切除术或肺段切除术患者围手术期结局的影响。收集了意大利电视辅助胸腔镜手术（VATS）登记处纳入的5088例接受VATS肺叶切除术或肺段切除术患者的数据。BMI（kg/m）根据世界卫生组织的分类进行划分：体重过轻、正常、超重、肥胖。采用线性回归模型评估BMI对结局（并发症、30天死亡率、无病生存期和总生存期）的影响，对于二元终点采用逻辑回归模型。在超重和肥胖患者中，手术时间随BMI值增加。超重患者的手术室时间增加5.54分钟（标准误=1.57），肥胖患者增加33.12分钟（标准误=10.26）（P<0.001）。与其他BMI类别相比，超重患者发生肺部、急性心脏、手术、重大及总体术后并发症的风险最低。在超重范围内，BMI从25增加到29.9对住院时间和任何并发症的风险没有显著影响，但肾并发症除外（比值比：1.55；95%置信区间：1.07-2.24；P=0.03），并且降低了持续性漏气的风险（比值比：0.8；95%置信区间：0.71-0.90；P<0.001）。体重过轻组的30天死亡率高于其他组。我们在无病生存期和总生存期方面未发现任何显著差异。根据我们的结果，肥胖会增加VATS肺大部切除术的手术室时间。超重患者在VATS切除术后发生肺部、急性心脏、手术、重大及总体术后并发症的风险最低。随着BMI偏离风险最低的点，向BMI值的两个极端变化，大多数术后并发症的风险会逐渐增加。体重过轻组的30天死亡率较高，无病生存期和总生存期无差异。
