The effect of lung volume reduction surgery on chronic obstructive pulmonary disease exacerbations.
BACKGROUND
Lung volume reduction surgery (LVRS) has been demonstrated to provide a functional and mortality benefit to a select group of subjects with chronic obstructive pulmonary disease (COPD). The effect of LVRS on COPD exacerbations has not been as extensively studied, and whether improvement in postoperative lung function alters the risk of disease exacerbations is not known.


OBJECTIVE
To examine the effect, and mechanism of potential benefit, of LVRS on COPD exacerbations by comparing the medical and surgical cohorts of the National Emphysema Treatment Trial (NETT).


METHODS
A COPD exacerbation was defined using Centers for Medicare and Medicaid Services data and International Classification of Diseases, Ninth Revision, discharge diagnosis.


RESULTS
There was no difference in exacerbation rate or time to first exacerbation between the medical and surgical cohorts during the year before study randomization (P = 0.58 and 0.85, respectively). Postrandomization, the surgical cohort experienced an approximate 30% reduction in exacerbation frequency (P = 0.0005). This effect was greatest in those subjects with the largest postoperative improvement in FEV(1) (P = 0.04) when controlling for changes in other spirometric measures of lung function, lung capacities, and room air arterial blood gas tensions. Finally, LVRS increased the time to first exacerbation in both those subjects with and those without a prior history of exacerbations (P = 0.0002 and P < 0.0001, respectively).


CONCLUSIONS
LVRS reduces the frequency of COPD exacerbations and increases the time to first exacerbation. One explanation for this benefit may be the postoperative improvement in lung function.
Washko
George R
GR
Pulmonary and Critical Care Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. gwashko@partners.org
Fan
Vincent S
VS
Ramsey
Scott D
SD
Mohsenifar
Zab
Z
Martinez
Fernando
F
Make
Barry J
BJ
Sciurba
Frank C
FC
Criner
Gerald J
GJ
Minai
Omar
O
Decamp
Malcolm M
MM
Reilly
John J
JJ
D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy; D016016:Proportional Hazards Models; D011656:Pulmonary Emphysema / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors