PURPOSE: Authors have reported that extremes of BMI or percentage ideal body weight (PIBW) can be correlated with increased perioperative morbidity and mortality and decreased long term survival in lung transplantation. Recipient selection plays an integral role in patient outcomes and has medical, social and financial ramifications. We reviewed our lung transplant database at the University of Wisconsin to assess the impact of BMI/PIBW on outcomes and resource utilization.
METHODS: Retrospective review of the lung transplant database from 1988-2006. BMI, percentage of ideal body weight, LOS, 90 day and overall survival were recorded. Univariate and multivariate of survival data was performed. Malnutrition was defined as PIBW<80% or BMI<18.5. Obesity PIBW>140 or BMI>30.
RESULTS: 310 patients underwent transplantation. 113 female , 197 male. 119 bilateral, 191 single lung. 45 patients had BMI <18.5, 32 patients BMI >30. 30 patients had PIBW <80%, 22 patients PIBW>140. 90 day mortality was 6% and did not differ significantly between groups. Mean LOS was 32, 30 and 26 days for BMI <18.5, >18.5-30, and >30 respectively. Overall survival did not differ between groups in multivariate analysis.
CONCLUSION: Indices of pre-operative malnutrition and obesity did not predict perioperative morbidity or mortality in this large cohort of LTx recipients. Extremes of nutritional status did not select for graft dysfunction or limit overall survival. Similarly cost estimates based on LOS did not vary between groups.
CLINICAL IMPLICATIONS: New parameters of BMI are more restrictive than our previous PIBW in the obese patient population. Changes in recipient selection are unlikely to alter resource utilization in our institution based on the above data. Mean hospital stay did decrease within our study period. This may eventually affect resource utilization for patients with morbid obesity and malnutrition.
DISCLOSURE: Nikhila Deo, No Financial Disclosure Information; No Product/Research Disclosure Information