title: Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema.
abstract: OBJECTIVE
  Numerous reports have confirmed the early benefits of lung volume reduction surgery for selected patients with emphysema. This report documents the long-term survival and functional results after lung volume reduction surgery.
  
  
  METHODS
  Between January 1993 and June 2000, a total of 250 consecutive patients underwent bilateral lung volume reduction surgery through median sternotomy at our institution. All patients had disabling dyspnea, thoracic hyperinflation, and a heterogeneous pattern of emphysema with suitable target areas for resection. Preoperative pulmonary rehabilitation was required and post-rehabilitation data were used as the baseline for data analysis. Follow-up ranged from 1.8 to 9.1 years (median 4.4 years).
  
  
  RESULTS
  Prolonged air leaks (>7 days) were the most common complication (45.2%, n = 113). Reexploration rates for air leak and bleeding were 3.2% (n = 8) and 1.2% (n = 3), respectively. Eighteen patients (7.2%) required reintubation and mechanical ventilation. The in-hospital mortality in this series was 4.8% (n = 12). The median length of hospitalization was 9 days (range 4-168 days). Kaplan-Meier survivals after lung volume reduction surgery were 93.6%, 84.4%, and 67.7% at 1, 3, and 5 years, respectively. Eighteen patients (7.2%) have subsequently undergone lung transplantation after a median interval of 4.3 years (range 2.1-6.4 years). Spirometric values, lung volumes, and gas exchange parameters improved after surgery. The forced expiratory volume in 1 second and the residual volume showed statistically significant improvements between preoperative values and each time point of follow-up. Health-related quality of life showed significant postoperative improvement and with time correlated well with the improvement in forced expiratory volume in 1 second.
  
  
  CONCLUSIONS
  Lung volume reduction surgery produces significant functional improvement for selected patients with emphysema. For most of these patients, benefits appear to last at least 5 years.
authors.affiliation: Washington University School of Medicine, Division of Cardiothoracic Surgery, Department of Surgery, St Louis, Mo, USA.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ciccone
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Guthrie
authors.forename: Gail E
authors.initials: GE
authors.lastname: Davis
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Lefrak
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.forename: Joel D
authors.initials: JD
authors.lastname: Cooper
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology; D016016:Proportional Hazards Models; D011656:Pulmonary Emphysema / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011659:Pulmonary Gas Exchange; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012115:Residual Volume; D012307:Risk Factors; D013147:Spirometry; D016019:Survival Analysis; D013997:Time Factors; D014109:Total Lung Capacity; D016896:Treatment Outcome