Obesity Increases Operating Time for Lung Cancer Surgery

Megan Brooks

November 27, 2012

Lobectomy for primary lung cancer takes longer in obese patients, driving up costs and resource use, a new study suggests.

The policy implications of this finding are clear. "As obesity increases, the cost and time required for patients requiring lung surgery will also increase," senior author Eric L. Grogan, MD, MPH, from the Vanderbilt University Medical Center in Nashville, Tennessee, told Medscape Medical News.

The study appears in the December issue of the Annals of Thoracic Surgery.

However, Dr. Grogan and colleagues report that obese patients had no increase in length of hospital stay, complication rate, or 30-day mortality, compared with nonobese patients, which is in agreement with findings from other studies.

In an invited commentary, David R. Jones, MD, from the Department of Surgery at the University of Virginia in Charlottesville, notes that obesity and lung cancer are 2 epidemics that are "increasingly appreciated" as significant threats to length and quality of life.

"This paper supports the need to more thoroughly examine how obesity impacts healthcare and resource allocation, particularly in the surgical population," he added in a statement.

Dr. Grogan and colleagues used the Society of Thoracic Surgeons General Thoracic Surgical database to determine whether obesity increases perioperative complications and resource use in patients undergoing resection for lung cancer.

"The analysis was prompted by our clinical observations that obese patients required more resources in the operating room to achieve good operative outcomes," Dr. Grogan told Medscape Medical News.

The analysis involved 19,337 patients. Mean body mass index (BMI) was 27.3 kg/m², but 4898 patients (25.3%) had a BMI of at least 30 kg/m².

Using operative times as a surrogate measure of perioperative resource use, the authors observed an additional 7.2 minutes in operative times for every 10-unit increase in BMI (P < .0001), which translates into increased cost and resource use.

With an estimated average operating room cost of $62/minute, every 10-unit increase in BMI costs approximately another $446, the authors calculate. And this is likely to be an underestimate.

The volume of lobectomy cases performed at the hospital did not affect the association between BMI and operative time; neither did the percentage of obese patients treated.

"As any clinician will attest, an additional 7 minutes of total operating room time for an obese patient hardly seems clinically significant," Dr. Jones points out. "However, I do not believe the authors consider this clinically relevant either. Instead, I think the intent of this publication is to begin the process of deducing the true cost of performing thoracic procedures in the ever-increasing obese population," he explains.

There is "no argument," Dr. Jones notes, "that more obese patients will require thoracic surgical procedures and that an improved understanding of how to best manage the twin epidemics of obesity and lung cancer is important."

The study authors and Dr. Jones have disclosed no relevant financial relationships.

Ann Thorac Surg. 2012;95:1841-1847. Abstract, Commentary