Lung-volume reduction surgery for pulmonary emphysema: Improvement in body mass index, airflow obstruction, dyspnea, and exercise capacity index after 1 year

Lederer, David J.; Thomashow, Byron M.; Ginsburg, Mark E.; Austin, John H.M.; Bartels, Matthew N.; Yip, Chun K.; Jellen, Patricia A.; Brogan, Frances L.; Kawut, Steven M.; Maxfield, Roger A.; DiMango, Angela M.; Simonelli, Paul F.; Gorenstein, Lyall A.; Pearson, Gregory D.N.; Sonett, Joshua R.

doi:10.1016/j.jtcvs.2006.12.062

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 6 , Pages 1434-1438, June 2007

Lung-volume reduction surgery for pulmonary emphysema: Improvement in body mass index, airflow obstruction, dyspnea, and exercise capacity index after 1 year

David J. Lederer, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Byron M. Thomashow, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Mark E. Ginsburg, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
John H.M. Austin, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY
Matthew N. Bartels, MD, MPH
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Chun K. Yip, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Patricia A. Jellen, MSN
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
Frances L. Brogan, MSN
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
Steven M. Kawut, MD, MS
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Roger A. Maxfield, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Angela M. DiMango, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Paul F. Simonelli, MD, PhD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Lyall A. Gorenstein, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
Gregory D.N. Pearson, MD, PhD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY
Joshua R. Sonett, MD
- New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
- Address for reprints: Joshua R. Sonett, MD, Columbia University College of Physicians and Surgeons, Division of Cardiothoracic Surgery, 622 W 168th St, PH 14, Room 104, New York, NY 10032.

Received 12 June 2006; received in revised form 15 November 2006; accepted 12 December 2006.

Objectives

We hypothesized that lung-volume reduction surgery for pulmonary emphysema would improve body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index, a multidimensional predictor of survival in chronic obstructive pulmonary disease. We also aimed to identify preoperative predictors of improvement in the BODE index.

Methods

In a prospective cohort study of patients undergoing lung-volume reduction surgery at our center, with the methodology of the National Emphysema Treatment Trial, we compared clinical characteristics before and 1 year after surgery with the Wilcoxon signed rank test. Changes in the BODE index were correlated with preoperative variables with the Spearman correlation coefficient.

Results

Twenty-three patients with predominantly upper-lobe pulmonary emphysema underwent lung-volume reduction surgery (14 by video-assisted thoracoscopic surgery, 9 by median sternotomy). There were no postoperative or follow-up deaths. The BODE index improved from a median of 5 (interquartile range 4-5) before surgery to 3 (interquartile range 2-4) 1 year after surgery (P < .0001). Improvements were seen in the lung function and dyspnea components of the BODE index. Lower preoperative 6-minute walk distance and lower postwalk Borg fatigue scores were each associated with greater improvement in the BODE index after 1 year.

Conclusion

Lung-volume reduction surgery for pulmonary emphysema improved the BODE index in patients with predominantly upper-lobe disease. Lower preoperative 6-minute walk distance correlated with greater improvement in the BODE index.

CTSNet classification: 11

Abbreviations and Acronyms: BODE, body mass index, airflow obstruction, dyspnea, and exercise capacity, COPD, chronic obstructive pulmonary disease, FEV₁, forced expiratory volume in 1 second, IQR, interquartile range, LVRS, lung-volume reduction surgery, NETT, National Emphysema Treatment Trial

Supported by National Institutes of Health grant HL072739.

PII: S0022-5223(07)00292-9

doi:10.1016/j.jtcvs.2006.12.062

Refers to article:

Lung-volume reduction surgery: A vanishing operation?
Keith S. Naunheim
The Journal of Thoracic and Cardiovascular Surgery June 2007 (Vol. 133, Issue 6, Pages 1412-1413)
- Full Text
- PDF (39 KB)