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


METHODS
Prospective data collection.


METHODS
A 320-bed community hospital.


METHODS
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.
Bagley
P H
PH
Medical Center of Central Massachusetts, Worcester, USA.
Davis
S M
SM
O'Shea
M
M
Coleman
A M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006745:Hospital Bed Capacity, 300 to 499; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010348:Patient Care Team; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data*; D016730:Program Development / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome