title: Sustained improvements in dyspnea and pulmonary function 3 to 5 years after lung volume reduction surgery.
abstract: OBJECTIVE
  To determine long-term survival rates of patients who underwent lung volume reduction surgery (LVRS) for emphysema and the factors associated with longer survival, and to evaluate levels of perceived dyspnea and health-related quality of life (HRQL) after a follow-up period of 3 to 5.5 years.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Academic medical center
  
  
  METHODS
  Telephone and postal surveys were used to obtain patient dyspnea scores and HRQL scores. Hospital databases and state registries were searched to determine patient survival and pulmonary function.
  
  
  RESULTS
  Of 54 patients undergoing LVRS, 29 patients (18 men and 11 women) were available for follow-up, which ranged from 36 to 66 months (mean +/- SE, 51 +/- 1.5 months). There was significant sustained improvement in modified Medical Research Council scores compared to pre-LVRS: 2.19 +/- 0.19 vs 2.88 +/- 0.14 (p = 0.0000). Eleven of 22 patients demonstrated an increase in all three Mahler baseline dyspnea index grades of at least one level. Baseline body mass index (BMI) and post-LVRS length of stay (LOS) were significantly associated with survival: survivor vs deceased baseline BMI, 24.2 +/- 0.6 vs 21.4 +/- 0.5 (p = 0.002), and post-LVRS LOS, 15.4 +/- 1.7 days vs 28.7 +/- 5.3 days (p = 0.015). Compared to pre-LVRS, 20 patients with mean follow-up time of 45 months demonstrated significant sustained improvements in FEV(1) percentage of predicted (31.4 +/- 2.1% vs 39.8 +/- 3.5%, p = 0.038), total lung capacity percentage of predicted (136 +/- 4% vs 122 +/- 3%, p = 0.0004), and residual volume percentage of predicted (237 +/- 14% vs 172 +/- 11%, p = 0.0001). Patient HRQL measured using the Dartmouth Primary Care Co-operative Quality of Life questionnaire was more favorable than that reported in aged-care settings. Caregiver burden scale scores indicate caring for a recipient of LVRS carries similar burden to that for caring for individuals with other chronic illnesses.
  
  
  CONCLUSIONS
  In this population, a majority of the LVRS patients survived for >/= 3 years. Among survivors, dyspnea and lung function benefits were seen. Baseline BMI and postoperative LOS were significantly associated with survival.
authors.affiliation: Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Appleton
authors.forename: Robert
authors.initials: R
authors.lastname: Adams
authors.forename: Samuel
authors.initials: S
authors.lastname: Porter
authors.forename: Morris
authors.initials: M
authors.lastname: Peacock
authors.forename: Richard
authors.initials: R
authors.lastname: Ruffin
mesh_terms: D000368:Aged; D017028:Caregivers; D004417:Dyspnea / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D015996:Survival Rate; D013997:Time Factors; D014109:Total Lung Capacity