Two-Year Improvement in Multidimensional Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index After Nonresectional Lung Volume Reduction Surgery in Awake Patients

Abstract

This study analyzed the comprehensive 2-year outcome of nonresectional lung volume reduction surgery (LVRS) in awake patients, including calculation of the multidimensional BODE index (body mass index, degree of airflow obstruction assessed by spirometry, modified Medical Research Council dyspnea grade, and 6-minute walking distance), which has proved a useful predictor of survival in patients with chronic obstructive pulmonary disease. The study cohort included 42 patients undergoing LVRS while awake within a staged bilateral program entailing unilateral LVRS, followed by contralateral treatment performed at the reappearance of disabling symptoms. Outcome measures included hospital stay, procedure-related costs, calculation of the multidimensional BODE index, actuarial survival, and freedom from contralateral LVRS. Results were compared with those of a control group undergoing resectional LVRS under general anesthesia. The groups were well matched in demographics and baseline measures. There was no operative mortality. Median hospital stay was significantly shorter in the awake group (6 days versus 9 days, p < 0.0001); median procedure-related costs were significantly lower in the awake group (euro5220 versus euro8580; p < 0.0001). At intergroup comparisons of awake versus control group of clinical results, the BODE index improved postoperatively in both groups (-2.24 +/- 1.0 versus -1.95 +/- 1.0, intergroup p = 0.35) and remained improved for up to 2 years (-1.95 +/- 1.3 versus -1.37 +/- 1.4, intergroup p = 0.1); 2-year survival and freedom from contralateral LVRS rates were 87% versus 91% (p = 0.52) and 74% versus 73% (p = 0.71), respectively. A significant improvement in the BODE index, satisfactory survival, and high rate of freedom from contralateral LVRS occurred both in the awake and control group, although the awake procedure proved more cost-effective.