title: Lung-volume reduction surgery for pulmonary emphysema: Improvement in body mass index, airflow obstruction, dyspnea, and exercise capacity index after 1 year.
abstract: 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.
authors.affiliation: New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.forename: Byron M
authors.initials: BM
authors.lastname: Thomashow
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ginsburg
authors.forename: John H M
authors.initials: JH
authors.lastname: Austin
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Bartels
authors.forename: Chun K
authors.initials: CK
authors.lastname: Yip
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Jellen
authors.forename: Frances L
authors.initials: FL
authors.lastname: Brogan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.forename: Roger A
authors.initials: RA
authors.lastname: Maxfield
authors.forename: Angela M
authors.initials: AM
authors.lastname: DiMango
authors.forename: Paul F
authors.initials: PF
authors.lastname: Simonelli
authors.forename: Lyall A
authors.initials: LA
authors.lastname: Gorenstein
authors.forename: Gregory D N
authors.initials: GD
authors.lastname: Pearson
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
mesh_terms: 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