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Sustained Improvements in Dyspnea and Pulmonary Function 3 to 5 Years After Lung Volume Reduction Surgery^*

^* From the Departments of Medicine (Ms. Appleton, and Drs. Adams and Ruffin) and Surgery (Mr. Peacock), University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia; private practice (Dr. Porter), Adelaide, SA, Australia.

Correspondence to: Robert Adams, MBBS, MD, Department of Medicine, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville, SA, Australia 5011; e-mail: robert.adams{at}nwahs.sa.gov.au

Objectives: 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.

Design: Retrospective observational study.

Setting: 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 FEV₁ 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.

Key Words: emphysema • lung diseases, obstructive • lung volume reduction surgery

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