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

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.

Key words:

Lung reduction surgery - Postoperative complication malnutrition - Body composition analysis - Bioelectrical impedance analysis - Fat-free mass

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

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