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Lung Volume Reduction Surgery at a Community Hospital : Program Development and Outcomes FREE TO VIEW

Peter H. Bagley; Steven M. Davis; Michael O'Shea; Anne-Marie Coleman
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From the Medical Center of Central Massachusetts, Worcester

1997 by the American College of Chest Physicians

Chest. 1997;111(6):1552-1559. doi:10.1378/chest.111.6.1552
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Study objectives: Description of the development and results of a program in lung volume reduction surgery (LVRS) at a community hospital.

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 were 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.




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