The influence of nutritional status on complications after operations for lung cancer.
BACKGROUND
Nutritional status is known to play an important role in determining outcome after many types of operations but its importance relative to nonnutritional indices in patients undergoing an operation for lung cancer is unclear.


METHODS
Detailed nutritional and nonnutritional assessment of 52 patients undergoing surgical resection of lung cancer was performed. The frequency of postoperative complications and length of intercostal drainage time were recorded, and the relation between preoperative indices and postoperative outcome was assessed.


RESULTS
Patients who died or needed reventilation had poorer nutritional status, worse lung function, and lower maximum expiratory pressures than those who did not. Using multiple logistic regression, the best model (R2 = 0.39) to predict death combined operation type, preoperative carbon monoxide transfer factor (% predicted), and maximum expiratory pressure (% predicted). Operation type and the fat-free mass index (FFMI) alone were only slightly less informative (R2 = 0.35). For reventilation the best model (R2 = 0.80) combined operation type, body mass index (BMI), and maximum expiratory pressure (% predicted). Intercostal drainage time after lobectomy was significantly related only to preoperative lymphocyte count (p = 0.004) and subjective global assessment score (p = 0.02).


CONCLUSIONS
Impaired nutrition is an important predictor of death and the need for reventilation after an operation for lung cancer, and the selection of patients for lung resection might be improved by measuring simple nutritional indices such as BMI and the FFMI.
Jagoe
R T
RT
Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom. tjagoe@hotmail.com
Goodship
T H
TH
Gibson
G J
GJ
D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome