REDUCED INCIDENCE OF AIR LEAKS AFTER AWAKE NON-RESECTIONAL LUNG VOLUME REDUCTION SURGERY

Objectives: Postoperative air leaks occur frequently after lung volume reduction surgery (LVRS) and can negatively affect both morbidity and hospital stay. We hypothesised that awake non-resectional LVRS could reduce occurrence of air leaks 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 incidence of prolonged (>7 days) air leaks; secondary outcome measures were: median duration of air leaks, 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. Criteria for discharge were standardised. Results: Intergroup comparison (awake vs. non-awake) showed that demographics and baseline data were well matched. There was no mortality. Prolonged air leaks occurred in 12 (18.2%) vs. 27 (40.9%) (P=0.007); Median air leaks duration was 4.5 days vs. 6.0 days (P<0.0002), with a hospital stay of 6 days vs. 9 days (P<0.0001). Other non-fatal complications occurred in 7 patients vs. 11 patients (P=0.4). Yet, early discharges were 12 (18%) vs. 4 (6%) (P=0.06). Reoperation for persistent air leaks was necessary in 0 vs. 2 patients (P=0.5). A significant correlation between prolonged air leaks and other complications was found in the awake group only (R=0.35, P=0.004). At 12 months, postoperative gain in functional parameters (FEV1 and RV/TLC ratio) was significant in both groups. Conclusions: In this study, awake non-resectional LVRS was associated with a reduced incidence and duration of air leaks when compared with the resectional procedure.