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J Thorac Cardiovasc Surg 2002;124:660-667
© 2002 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

Body weight and nutritional changes after reduction pneumoplasty for severe emphysema: A randomized study

Tommaso Claudio Mineo, MDa, Vincenzo Ambrogi, MDa, Eugenio Pompeo, MDa, Patrizio Bollero, MDa, Davide Mineo, MDa, Italo Nofroni, MDb Pulmonary Emphysema Research Group*

From the Division of Thoracic Surgery,a Tor Vergata University, and the Department of Experimental Medicine and Pathology,b La Sapienza University, Rome, Italy.

The Pulmonary Emphysema Research Group is supported by grant 9906274194-06 of Ministero dell'Università e della Ricerca Scientifica e Tecnologica and partially by CNR n. CU0100935CT26 2002.

Received for publication Oct 1, 2001. Revisions requested Dec 7, 2001; revisions received Jan 11, 2002. Accepted for publication Jan 23, 2002. Address for reprints: Tommaso Claudio Mineo, MD, Cattedra di Chirurgia Toracica, Università Tor Vergata, Policlinico Tor Vergata, Via Oxford, 81, 00133 Rome, Italy (E-mail: mineo{at}med.uniroma2.it).

Background: The impact of reduction pneumoplasty on body weight and nutritional status has not previously been tested in a controlled study.
Methods: We investigated 60 patients with severe emphysema who were randomly assigned to receive either reduction pneumoplasty (n = 30) or a 6-week respiratory rehabilitation program (n = 30). Nutritional status was evaluated by means of body mass index, triceps skin fold measurement, midarm muscle circumference, and biochemical blood values. Fat mass and fat-free mass were calculated by bioelectric impedance. Two treatment-related deaths occurred after reduction pneumoplasty and 1 death occurred after respiratory rehabilitation.
Results: Functional and subjective improvements were significantly showed in reduction pneumoplasty group. Despite insignificant differences in energy intake, the reduction pneumoplasty group showed significant gain (P < .0001) relative to the respiratory rehabilitation group in mean weight changes at 3 months (1.82 ± 2.63 kg vs -0.57 ± 2.25 kg), 6 months (2.87 ± 3.79 kg vs -1.11 ± 2.64 kg), and 12 months (3.29 ± 4.01 kg vs -0.95 ± 1.90 kg). Both fat mass and fat-free mass increased after surgery, but only fat-free mass had a significant improvement (P = .001). Six-month weight gain in the reduction pneumoplasty group was significantly correlated with low baseline weight ({rho} = -0.437, P = .02) and residual volume reduction ({rho} = -0.446, P = .01). Total proteins (P = .003), albumin (P = .03), transferrin (P = .04), cholesterol (P = .003), hemoglobin (P = .01), triceps skin fold measurement (P < .0001), and midarm muscle circumference (P < .0001) were significantly increased only in the reduction pneumoplasty group. Conversely, in the respiratory rehabilitation group no nutritional index was significantly increased at 6 months after rehabilitation.
Conclusions: Body weight and nutritional status improved only after reduction pneumoplasty and not after respiratory rehabilitation, and this was significantly related to fat-free mass increment. In the reduction pneumoplasty group, the residual volume result was significantly correlated with postoperative weight gain.




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