Two-Year Improvement in Multidimensional Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index After Nonresectional Lung Volume Reduction Surgery in Awake Patients

Abstract

Background. This study analyzed the comprehensive 2-year outcome of nonresectional lung volume reduction surgery (LVRS) in awake patients, including calculation of the multidimensional BODE index (body mass index, degree of airflow obstruction assessed by spirometry, modified Medical Research Council dyspnea grade, and 6-minute walking distance), which has proved a useful predictor of survival in patients with chronic obstructive pulmonary disease.Methods. The study cohort included 42 patients undergoing LVRS while awake within a staged bilateral program entailing unilateral LVRS, followed by contralateral treatment performed at the reappearance of disabling symptoms. Outcome measures included hospital stay, procedure-related costs, calculation of the multidimensional BODE index, actuarial survival, and freedom from contralateral LVRS. Results were compared with those of a control group undergoing resectional LVRS under general anesthesia.Results. The groups were well matched in demographics

The modified BODE index: validation with mortality in COPD

“…The BODE index also predicts hospitalisations and outcome following LVRS and pulmonary rehabilitation [17][18][19][20][21]. The BODE index incorporates the 6MWD as a measure of exercise capacity.…”

“…The BODE index, which incorporates measurements of nutrition (body mass index), airflow obstruction (forced expiratory volume in one second (FEV1)), dyspnoea (Modified Medical Research Council dyspnoea scale) and exercise capacity as measured by the 6MWD, predicts mortality [16,17], hospitalisations [18] and reflects disease modification after LVRS [19], nonsurgical volume reduction [20], and pulmonary rehabilitation [21]. It also reflects the deleterious effects of exacerbations and hospitalisations [22].…”

“…This indicates that the differences between tests in the patients with COPD may not be as large as otherwise suspected. There is a modest but significant correlation between V9O 2 and 6-min walking distance (6MWD) [13,14], implying that the tests are not equal; however, as it relates to the capacity to predict survival in COPD, the current authors have recently shown that the 6MWD is equal to, if not better than, V9O 2 at predicting this outcome [15].The BODE index, which incorporates measurements of nutrition (body mass index), airflow obstruction (forced expiratory volume in one second (FEV1)), dyspnoea (Modified Medical Research Council dyspnoea scale) and exercise capacity as measured by the 6MWD, predicts mortality [16,17], hospitalisations [18] and reflects disease modification after LVRS [19], nonsurgical volume reduction [20], and pulmonary rehabilitation [21]. It also reflects the deleterious effects of exacerbations and hospitalisations [22].…”

Nonpharmacological treatment and relief of symptoms in COPD: Table 1—

“…These include bronchoscopic LVRS and endobronchial valve placement [68,69]. Both have shown preliminary results in which improvements in exercise capacity and dynamic hyperinflation have been reported [70].…”

Surgical Management of Prolonged Air Leak in Patients with Underlying Emphysema

“…For lung volume reduction surgery, an alternative technique involving no cut plication has been described by various authors as having lower rates of prolonged air leak while having short to intermediate term improvement in pulmonary function comparable to conventional lung volume reduction surgery (44)(45)(46)(47). With this alternative technique, lung tissue is folded up or pushed down onto itself before being stapled together instead of performing staple excision of lung tissue in traditional lung volume reduction surgery.…”