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Duration of air leak is reduced after awake nonresectional lung volume reduction surgery

Emphysema Center, Department of Thoracic Surgery, Tor Vergata University, Rome, Italy

Received 2 September 2008; received in revised form 24 December 2008; accepted 8 January 2009.

^_* Corresponding author. Address: Cattedra di Chirurgia Toracica, Policlinico Universitario Tor Vergata, V.le Oxford, 81, 00133 Rome, Italy. Tel.: +39 0620902884; fax: +39 0620902881. (Email: pompeo{at}med.uniroma2.it).

Objective: Prolonged air leak occurs frequently after lung volume reduction surgery (LVRS) and can negatively affect both morbidity and hospital stay. We hypothesised that awake nonresectional LVRS could reduce the duration of air leak in emphysema patients. Methods: This analysis included 66 patients undergoing awake, unilateral plication of the most emphysematous lung regions under sole epidural anaesthesia. Primary outcome measure was the rate of prolonged (>7 days) air leak; secondary outcome measures included the mean duration of air leak, hospital stay and early discharges (4 days). All results were retrospectively compared with those of a similar control group undergoing resectional LVRS under general anaesthesia. Results: Intergroup comparisons showed that demographics and baseline data were well matched. Prolonged air leak occurred in 12 patients (18%) in the awake group versus 27 patients (40%) in the control group (p = 0.007) with a mean duration of 5.2 ± 6.5 days versus 7.9 ± 7.6 days (p < 0.0002). Mean hospital stay was significantly shorter in the awake group (6.3 ± 2.8 days vs 9.2 ± 5.6 days, p < 0.0001). At univariate analysis, resectional LVRS (p = 0.007), higher severity of emphysema (p < 0.0001) and lower diffusion capacity for carbon monoxide (p = 0.0001) correlated with occurrence of prolonged air leak; however, logistic regression indicated high severity of emphysema as the most important factor predicting prolonged air leak (odds ratio = 4.85, p < 0.0001). At 6 months, dyspnoea index, FEV1 and 6 min walking test improved significantly in both study groups. Conclusions: In this study, awake nonresectional LVRS was associated with a lower rate of prolonged air leak and a shorter hospital stay than the standard resectional technique.

Key Words: Emphysema • LVRS • Air leak • VATS • Complication • Awake thoracic surgery