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


CONCLUSIONS
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.
Lederer
David J
DJ
New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Thomashow
Byron M
BM
Ginsburg
Mark E
ME
Austin
John H M
JH
Bartels
Matthew N
MN
Yip
Chun K
CK
Jellen
Patricia A
PA
Brogan
Frances L
FL
Kawut
Steven M
SM
Maxfield
Roger A
RA
DiMango
Angela M
AM
Simonelli
Paul F
PF
Gorenstein
Lyall A
LA
Pearson
Gregory D N
GD
Sonett
Joshua R
JR
D000402:Airway Obstruction / Q000503:physiopathology; D015992:Body Mass Index; D004417:Dyspnea / Q000503:physiopathology; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000503:physiopathology* / Q000601:surgery*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis