Lung volume reduction surgery at a community hospital - Program development and outcomes

Study objectives: Description of the development and results of a program in l Design: Prospective data collection. Setting: A 320-bed community hospital. Patients: Fifty-five patients consecutively discharged from the hospital following LVRS. The mean preoperative FEV1 averaged 28% (+/-8%) of predicted values, while the preoperative PaCO2 averaged 49 mm Hg (+/-11.5 mm Hg). Forty-eight patients completed a preoperative conditioning regimen and underwent the procedure on an elective basis. Seven patients underwent the procedure during a hospital admission for a COPD exacerbation. Eight patients required mechanical ventilation preoperatively including three who had required long-term mechanical ventilatory support. Results: Three patients (5%) died in the hospital following surgery. One patient developed chronic ventilator dependence. All three of the patients who required long-term mechanical ventilation preoperatively were weaned from the ventilator and returned home. Follow-up pulmonary function testing is available for 42 patients 3 months after surgery, and for 20 patients 6 months after the operation. At 3 months, the mean FEV1 improved 0.19 L (p = 0.0002), the mean improvement for FVC was 0.37 L (p = 0.0001), and the mean drop in residual volume was 0.97 L (p = 0.0001). Similar changes are seen at 6 months. Highly significant improvements vc ere also seen in quality of life measurements and exercise performance. The benefits of surgical treatment of emphysema seemed similar in both elective and urgent groups. Conclusions: LVRS can be done safely and effectively at a community hospital, with significant improvement in pulmonary function and quality of life.