The impact of nutritional status on the outcome of lung volume reduction surgery - A prospective study

Objectives: To study the incidence and clinical significance of nutritional deficiencies in patients with emphysema undergoing lung volume reduction s urgery (LVRS). Design: Prospective observational study. Setting: University-based teaching hospital. Patients: Fifty-one consecutiv e patients with end-stage emphysema undergoing video-assisted thoracoscopic surgery for LVRS. Interventions: All patients had their body mass index (BMI) and serum nutri tional indexes (albumin, transferrin, total protein, cholesterol) measured preoperatively and postoperatively, Various clinical parameters were also c ompared between two groups. Results: The BMI was normal in 24 patients (47%), and 27 patients (53%) had a below normal BMI. A preoperative analysis of the serum nutritional index es revealed no clinically significant differences between the two groups, b ut postoperative levels were significantly lower in the low BMI group. Anth ropometric measurements supported the designation of nutritional status by BMI. Clinically, 26% of the patients in the low BMI group required prolonge d ventilatory support (> 24 h), compared to only 4% of the patients with a normal BMI. The hospital length of stay (LOS) also differed, averaging 15.9 days in the low BMI group, compared to an average of 11.8 days in the norm al BMI group. Conclusion: Approximately 50% of patients undergoing LVRS for emphysema hav e a deficient nutritional status identifiable by BMI, but not by standard n utritional indexes. This impaired nutritional status is associated with inc reased morbidity following LVRS, We suggest that BMI is an accurate determi nant of nutritional status in this patient population, and we speculate tha t preoperative repletion of nutritional deficiencies may decrease hospital morbidity, hospital LOS, and overall costs in the malnourished population u ndergoing LVRS.