Lung volume reduction surgery at a community hospital: program development and outcomes

Chest. 1997 Jun;111(6):1552-9. doi: 10.1378/chest.111.6.1552.

Abstract

Study objectives: Description of the development and results of a program in lung volume reduction surgery (LVRS) at a community hospital.

Design: Prospective data collection.

Setting: A 320-bed community hospital.

Patients: Fifty-five patients consecutively discharged from the hospital following LVRS. The mean preoperative FEV1 averaged 28% (+/-8%) of predicted values, while the preoperative PaCO2 averaged 49 mm Hg (+/-11.5 mm Hg). Forty-eight patients completed a preoperative conditioning regimen and underwent the procedure on an elective basis. Seven patients underwent the procedure during a hospital admission for a COPD exacerbation. Eight patients required mechanical ventilation preoperatively, including three who had required long-term mechanical ventilatory support.

Results: Three patients (5%) died in the hospital following surgery. One patient developed chronic ventilator dependence. All three of the patients who required long-term mechanical ventilation preoperatively were weaned from the ventilator and returned home. Follow-up pulmonary function testing is available for 42 patients 3 months after surgery, and for 20 patients 6 months after the operation. At 3 months, the mean FEV1 improved 0.19 L (p=0.0002), the mean improvement for FVC was 0.37 L (p=0.0001), and the mean drop in residual volume was 0.97 L (p=0.0001). Similar changes are seen at 6 months. Highly significant improvements were also seen in quality of life measurements and exercise performance. The benefits of surgical treatment of emphysema seemed similar in both elective and urgent groups.

Conclusions: LVRS can be done safely and effectively at a community hospital, with significant improvement in pulmonary function and quality of life.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Elective Surgical Procedures / statistics & numerical data
  • Emergencies
  • Female
  • Follow-Up Studies
  • Hospital Bed Capacity, 300 to 499
  • Hospitals, Community* / statistics & numerical data
  • Humans
  • Male
  • Massachusetts
  • Middle Aged
  • Patient Care Team*
  • Patient Selection
  • Pneumonectomy / methods
  • Pneumonectomy / statistics & numerical data*
  • Program Development* / statistics & numerical data
  • Prospective Studies
  • Quality of Life
  • Treatment Outcome