Objectives: To study the incidence and clinical
significance of nutritional deficiencies in patients with emphysema
undergoing lung volume reduction surgery (LVRS).
Design: Prospective observational study.
Setting: University-based teaching hospital.
Patients: Fifty-one consecutive patients with end-stage
emphysema undergoing video-assisted thoracoscopic surgery for
Interventions: All patients had their body mass
index (BMI) and serum nutritional indexes (albumin, transferrin, total
protein, cholesterol) measured preoperatively and postoperatively.
Various clinical parameters were also compared 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 indexes revealed no clinically significant
differences between the two groups, but postoperative levels were
significantly lower in the low BMI group. Anthropometric measurements
supported the designation of nutritional status by BMI. Clinically,
26% of the patients in the low BMI group required prolonged
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 normal BMI group.
Approximately 50% of patients undergoing LVRS for emphysema have a
deficient nutritional status identifiable by BMI, but not by standard
nutritional indexes. This impaired nutritional status is associated
with increased morbidity following LVRS. We suggest that BMI is an
accurate determinant of nutritional status in this patient population,
and we speculate that preoperative repletion of nutritional
deficiencies may decrease hospital morbidity, hospital LOS, and overall
costs in the malnourished population undergoing LVRS.