title: National perioperative outcomes of pulmonary lobectomy for cancer in the obese patient: a propensity score matched analysis.
abstract: OBJECTIVE
  Obesity in the United States is a growing epidemic that results in challenging patients with complicated comorbidities. We sought to compare hospital outcomes of obese patients with those of nonobese patients undergoing pulmonary lobectomy for cancer.
  
  
  METHODS
  We performed a retrospective cohort analysis of obese (body mass index ≥ 30 kg/m(2)) and nonobese (body mass index < 30 kg/m(2)) patients undergoing pulmonary lobectomy for lung cancer. By using the Nationwide Inpatient Sample database from 2002 to 2007, we determined independent risk factors for perioperative death, discharge to an institutional care facility, and prolonged hospital length of stay (>14 days). Cohorts were matched on the basis of propensity scores incorporating preoperative patient variables.
  
  
  RESULTS
  We identified 1238 obese patients (3.7%) and 31,983 nonobese patients (96.3%) undergoing lobectomy for cancer. In regard to patient demographics, obese patients were younger (mean age, 64.8 vs 66.7, P < .001) and predominantly female (59.5% vs 50.0%, P < .001) compared with nonobese patients. After matching based on propensity scores, except for a greater incidence of pulmonary insufficiency (P = .03) and pneumonia (P = .01) in the obese group, there were no differences in postoperative complications. By controlling for patient demographics, obese patients had higher odds to be discharged to an institutional care facility (odds ratio, 1.21; P = .02) but not for prolonged hospital length of stay or perioperative death.
  
  
  CONCLUSIONS
  Obese patients have an increased risk for postoperative pulmonary complications but not other morbidity, mortality, or prolonged hospital length of stay after lobectomy for cancer. Obesity should not be considered a surgical risk factor for pulmonary resection.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Launer
authors.forename: Danh V
authors.initials: DV
authors.lastname: Nguyen
authors.forename: David T
authors.initials: DT
authors.lastname: Cooke
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D010351:Patient Discharge; D018579:Patient Selection; D059035:Perioperative Period; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011014:Pneumonia / Q000401:mortality; D057216:Propensity Score; D012131:Respiratory Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States