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J Thorac Cardiovasc Surg 2007;133:1434-1438
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Lung-volume reduction surgery for pulmonary emphysema: Improvement in body mass index, airflow obstruction, dyspnea, and exercise capacity index after 1 year

David J. Lederer, MDa,b, Byron M. Thomashow, MDa,b, Mark E. Ginsburg, MDa,c, John H.M. Austin, MDa,d, Matthew N. Bartels, MD, MPHa,e, Chun K. Yip, MDa,b, Patricia A. Jellen, MSNa, Frances L. Brogan, MSNa, Steven M. Kawut, MD, MSb, Roger A. Maxfield, MDa,b, Angela M. DiMango, MDa,b, Paul F. Simonelli, MD, PhDa,b, Lyall A. Gorenstein, MDa,c, Gregory D.N. Pearson, MD, PhDa,d, Joshua R. Sonett, MDa,c,*

a New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY
b Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
c Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
d Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY
e Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, NY.

Received for publication June 12, 2006; revisions received November 15, 2006; accepted for publication December 12, 2006.

* Address for reprints: Joshua R. Sonett, MD, Columbia University College of Physicians and Surgeons, Division of Cardiothoracic Surgery, 622 W 168th St, PH 14, Room 104, New York, NY 10032. (Email: js2106{at}columbia.edu).

Objectives: 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.

Conclusion: 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.

Abbreviations and Acronyms BODE = body mass index, airflow obstruction, dyspnea, and exercise capacity; COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second; IQR = interquartile range; LVRS = lung-volume reduction surgery; NETT = National Emphysema Treatment Trial


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