Early and Long-Term Outcomes After Non-Intubated, Non-Resectional Lung Volume Reduction Surgery

Abstract

Objective: In 2001, the introduction of non-resectional lung volume reduction surgery (LVRS) enabled surgery under non-intubated anaesthesia. This study compares this combined technique to a group of patients with a similar disorder who refused non-intubated anaesthesia. Methods: Between January 2001 and October 2015, 108 patients with severe emphysema underwent non-resectional LVRS under non-intubated anaesthesia. During the same period, another 15 patients scheduled for LVRS refused non-intubated surgery and underwent the same procedure under traditional intubated modality. Respiratory and functional parameters were evaluated. Time to residual volume recurrence and overall survival were analysed with the Kaplan–Meier method. Results: Thirteen cases (12%) required intubation due to tenacious pleuropulmonary adhesions (n=7) or intolerance (n=6). Compared with the intubated group, the non-intubated group were found to have significantly better results in post-operative partial pressure of carbon dioxide in arterial blood (PaCO2) (45±8 versus 52±8 mmHg; p=0.04), global operative time (41±24 versus 72±31 minutes; p=0.01), non-fatal complication rate (13.6% versus 33.3%; p=0.029), and especially postoperative pneumonia rate (3.1% versus 33.3%; p=0.004); patient satisfaction for anaesthesia was also improved in the non-intubated group (3.6±1.2 versus 2.8±1.7; p=0.03). Mean air leakage (5.3±3.5 versus 6.1±4.6 days), hospital stay (6.3±4.8 versus 8.0±6.1 days), and 90 days postoperative mortality rate (1.0% versus 6.6%) were lower, yet not significantly, in the non-intubated cohort. All mean respiratory and symptomatic parameters significantly improved in both groups, with no intergroup significant difference, and persisted for 4 years after surgery. Mean follow-up for the non-intubated group was 78±30 months. Analysis of time to residual volume recurrence and overall survival showed no statistically significant intergroup difference. Conclusion: Non-intubated, non-resectional LVRS presents a 90-day postoperative non-fatal complication rate and patient satisfaction for non-intubated anaesthesia that are significantly better than intubated procedures. The long-term outcomes were similar between both groups.