高体质指数对术后结果的明显保护作用，即“肥胖悖论”，被认为反映了没有肥胖的患者相对虚弱的状况。我们希望研究体质指数与解剖性肺切除术后结果之间的独立关联。我们在2012年至2020年的全国外科质量改善计划中找到了所有进行选择性肺切除手术治疗癌症的成年患者。修订后的脆弱指数量化了患者脆弱程度。营养不良定义为术前血清白蛋白＜3.5g/dL。多变量回归分析用于研究体质指数与重大不良事件（定义为30天死亡率、术后并发症和非计划复查手术的综合指标）之间的独立关联。 估计符合研究条件的患者为20,099例，其中6,424例（32.0％）患有肥胖。相对于其他人，肥胖患者明显年轻（49.3岁对50.3岁），更常见为白人（78.1％对74.9％），而且脆弱患者更为频繁（修订后的脆弱指数＞1：35.7％对22.5％，P < .001）。两组之间营养不良率（7.6％对8.4％，P＝.05）和切除范围没有显著差异。经调整后，肥胖与重大不良事件的概率减少相关（调整后比值比0.86，95％置信区间0.78-0.94）。 当前研究结果在解剖性肺切除领域证实了经典的肥胖悖论，尽管我们已经对脆弱和营养不良进行了调整。有必要进行进一步研究以揭示此关联的性质；然而，我们的结果能够为优化手术干预的风险分层和患者选择提供信息。 版权所有 © 2023 作者。由Elsevier Inc.出版。保留所有权利。

The apparent protective effect of high body mass index on postoperative outcomes, termed the "obesity paradox," has been postulated to reflect the relative frailty of patients without obesity. We wanted to examine the independent association between body mass index and outcomes after anatomic lung resection.All adults undergoing elective lung resection for cancer were identified in the 2012-2020 National Surgical Quality Improvement Program. The modified Frailty Index quantified degree of patient frailty. Malnutrition was defined as a preoperative serum albumin <3.5g/dL. Multivariable regressions were used to examine the independent association of body mass index and major adverse events, analyzed as a composite of 30-day mortality, postoperative complications, and unplanned reoperation.Of an estimated 20,099 patients meeting study criteria, 6,424 (32.0%) had obesity. Relative to others, patients with obesity were significantly younger (49.3 vs 50.3 years), more commonly White (78.1 vs 74.9%), and more frequently frail (modified Frailty Index >1: 35.7 vs 22.5%, all P < .001). There was no significant difference in malnutrition rates (7.6 vs 8.4%, P = .05) or extent of resection between groups. After adjustment, obesity was associated with decreased odds of major adverse events (adjusted odds ratio 0.86, 95% confidence interval 0.78-0.94).The present findings uphold the canonical obesity paradox in anatomic lung resection, despite adjustment for frailty and malnutrition. Further studies are warranted to characterize the nature of this association; however, our results may inform efforts to optimize risk stratification and patient selection for surgical intervention.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.