Thorac Cardiovasc Surg 2001; 49(4): 216-220
DOI: 10.1055/s-2001-16110
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

The Effect of Nutritional Status on Morbidity in COPD Patients Undergoing Bilateral Lung Reduction Surgery[]

K. Nezu, M. Yoshikawa, T. Yoneda, K. Kushibe, T. Kawaguchi, M. Kimura, A. Kobayashi, H. Takenaka, A. Fukuoka, N. Narita, S. Taniguchi
  • Department of Surgery III and the Second Department of Internal Medicine, Nara Medical University, Nara, Japan
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Publikationsverlauf

Publikationsdatum:
31. Dezember 2001 (online)

Background: Although candidates for lung reduction surgery (LRS) include malnourished patients with severe chronic obstructive pulmonary disease (COPD), the impact of preoperative nutritional status on surgical outcome has not been clearly elucidated. Methods: We investigated the relationship between preoperative nutritional status and postoperative morbidity in 23 consecutive patients undergoing LRS. The percentage of ideal body weight (%IBW) and body mass index (BMI) were calculated, and fat-free mass (FFM) and fat mass (FM) were measured using a bioelectrical impedance analyzer. FFM and FM were expressed as height-normalized indices, FFM index [FFM (kg)/height (m)2, or FFMI] and FM index [FM (kg)/height (m)2, or FMI]. Serum levels of total protein and albumin were also determined. Results: 8 patients had major complications. Preoperative %IBW and FFMI were significantly lower among patients with major complications, while no significant differences were observed in pulmonary function, FMI or serum protein. The complication rate was significantly higher among patients with low FFMI (FFMI ≤ 16) but not with low %IBW or BMI. Conclusion: These results suggest that FFM depletion is an excellent predictor of unacceptable postoperative complication following LRS.

1 Presented in part at the Fiftythird Annual Meeting of The Japanese Society of Thoracic Surgeons, Ohita, Japan, Oct 2000

References

  • 1 Cooper J D, Patterson G A, Sundaresan R S. et al . Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema.  J Thorac Cardiovasc Surg. 1996;  112 1319-1330
  • 2 Kotloff R M, Tino G, Bavaria J E. et al . Bilateral lung volume reduction surgery for advanced emphysema. A comparison of median sternotomy and thoracoscopic approaches.  Chest. 1996;  110 1399-1406
  • 3 McKenna R J, Brenner M, Fischel R J, Gelb A F. Should lung volume reduction for emphysema be unilateral or bilateral?.  J Thorac Cardiovasc Surg. 1996;  112 1331-1339
  • 4 Weinmann G G, Hyatt R. Evaluation and research in lung volume reduction surgery.  Am J Respir Crit Care Med. 1996;  154 1913-1918
  • 5 Japanese Ministry of Welfare and Health, Health Service Bureau, Health Promotion and Nutrition Division .Recommended dietary allowances for the Japanese, 6th revision. Daiichi Shuppan, Tokyo 1999: 244
  • 6 Lukaski H C, Johnson P E, Bolonchuk W W, Lykken G L. Assessment of fat-free mass using bioelectrical impedance measurements of the human body.  Am J Clin Nutr. 1985;  41 810-817
  • 7 Baarends E M, Schols A MWJ, Mostert R . et al . Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease.  Eur Respir J. 1997;  10 2807-2813
  • 8 Keenan R J, Landreneau R J, Sciurba F C. et al . Unilateral thoracoscopic surgical approach for diffuse emphysema.  J Thorac Cardiovasc Surg. 1996;  111 308-316
  • 9 Szekely L S, Oelberg D A, Wright C. et al . Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery.   Chest. 1997;  lll 550-558
  • 10 Wilson D O, Rogers R M, Wright E C, Anthonisen N R. Body weight in chronic obstructive pulmonary disease. The national institutes of health intermittent positive-pressure breathing trial.  Am Rev Respir Dis. 1989;  139 1435-1438
  • 11 Arora N S, Rochester D F. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients.  Am Rev Res Dis. 1982;  126 195-199
  • 12 Mentzer S J, Reilly J J, DeCamp M M. et al . Nutritional status and lung function in patients evaluated for lung volume reduction surgery.  Chest. 1997;  112 123S
  • 13 Mazolewski P, Turner J F, Baker M. et al . The impact of nutritional status on the outcome of lung volume reduction surgery. A prospective study.  Chest. 1999;  116 693-696
  • 14 Dahrén I, Lindberg E, Janson C, Stålenheim G. Delayed type of hypersensitivity and late allergic reactions in patients with stable COPD.  Chest. 1999;  116 1625-1631
  • 15 Schols A MWJ, Soeters P B, Dingemans A MC. et al . Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation.  Am Rev Respir Dis. 1993;  147 1151-1156
  • 16 Sandberg L B, Owens A J, van Recken D E. et al . Improvement in plasma protein concentrations with fibronectin treatment in severe malnutrition.  Am J Clin Nutr. 1990;  52 651-656
  • 17 Morley J E. Nutritional status of elderly.  Am J Med. 1986;  81 679-695
  • 18 Kobayashi A, Yoneda T, Yoshikawa M. et al . The relation of fat-free mass to maximum exercise performance in patients with chronic obstructive pulmonary disease.  Lung. 2000;  178 119-127
  • 19 Elpern E H, Behner K G, Klontz B. et al . Lung volume reduction surgery. An analysis of hospital costs.  Chest. 1998;  113 896-899
  • 20 Hazelrigg S R, Boley T M, Magee M J. et al . Comparison of staged thoracoscopy and median sternotomy for lung volume reduction.  Ann Thorac Surg. 1998;  66 1134-1139

1 Presented in part at the Fiftythird Annual Meeting of The Japanese Society of Thoracic Surgeons, Ohita, Japan, Oct 2000

Masanori Yoshikawa MD 

Second Department of Internal Medicine
Nara Medical University

840 Shijo-cho, Kashihara

Nara, 634-8522

Japan

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