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

Abstract

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 (p = -0.437, P = .02) and residual volume reduction (p = -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.