Comparative results of non-resectional lung volume reduction performed by awake or non-awake anesthesia

In a prospective non-randomized study, we compared results and costs of non-resectional lung volume reduction surgery (LVRS) performed through awake or non-awake anesthesia that was freely chosen by recruited patients.

Non-resectional LVRS was performed by epidural anesthesia in 41 patients (awake group) and by general anesthesia in 19 patients (non-awake group). Perioperative outcome included analysis of oxygenation (PaO(2)/FiO(2)) at fixed time points and global time spent in the operating room (anesthesia plus surgery plus weaning plus recovery times). Costs were evaluated at discharge. Forced expiratory volume in 1s (FEV(1)), plethysmographic residual volume (RV(plet)) and maximal incremental treadmill test (MITT) score were assessed preoperatively and every 6 months, postoperatively.

Perioperative outcome was better in the awake group with better oxygenation 1h after the operation (P=0.004) and shorter global in-operating room stay (P<0.0001). There was no operative mortality. In the awake group, median hospital stay was shorter (6 days vs 7 days, P=0.006), whereas median hospital charges were lower than in the non-awake group (7800 euros vs 8600 euros, P=0.006). At 6 months, there was no difference (awake vs non-awake) in median ΔFEV (0.33l vs 0.28l, P=0.09), ΔRV (-0.99l vs -0.98l, P=0.95), and ΔMITT score (1.0 vs 0.75, P=0.31).

In our study, awake non-resectional LVRS was preferred by the majority of patients. It resulted in better perioperative outcome, shorter hospital stay, and lower costs than equivalent procedures performed by non-awake anesthesia. Six months' clinical results were comparable, showing that the awake approach had no impact on late clinical benefit.