• Federico Tacconi, Eugenio Pompeo, and Tommaso Claudio Mineo.
• Department of Thoracic Surgery, Emphysema Center, Tor Vergata University, Rome, Italy.
• Eur J Cardiothorac Surg. 2009 May 1; 35 (5): 822-8; discussion 828.

ObjectiveProlonged 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.MethodsThis 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 (ResultsIntergroup 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.ConclusionsIn 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.

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