Postoperative Improvement after Lung Volume Reduction Surgery for Severe Emphysema Is Not Affected by Sex

Lung volume reduction surgery (LVRS) is an established treatment for selected emphysema patients. Because Chronic obstructive pulmonary disease differs by sex in aetiology, symptom perception, and treatment response, we examined whether these differences affect LVRS outcomes.

All consecutive LVRS patients (August 2019-May 2025) were included and stratified by sex (111 men, 96 women). Propensity-score matching (PSM) (caliper 0.01, optimal matching) balanced age, body mass index, forced expiratory volume in 1 s (FEV₁), RV, type of surgery, oxygen use, azithromycin, and emphysema morphology between groups. Endpoints were changes from baseline in pulmonary function (FEV₁, RV), exercise capacity (6-min walking distance [6MWD] and Quality of Life [QoL]) (St. George's respiratory questionnaire [SGRQ]) at 3 and 6 months; as well as transplant-free survival.

After PSM, 81 men and 81 women were included. Pack-years were similar (40 vs. 39; p = 0.060). Baseline characteristics were comparable after matching, but men had longer 6MWD (382 vs. 332 m; p = 0.011). At 3 months, improvements were comparable for FEV₁ %pred (+11% vs. +9%; p = 0.22), RV (-59% vs. -48%; p = 0.49), and 6MWD (+57 m vs. +54 m; p = 0.47), whereas SGRQ improved more in men (-19 vs. -11 points; p = 0.020). At 6 months, changes in FEV₁ %pred, 6MWD and SGRQ were similar between sexes. Three-year transplant-free survival was comparable (81% [95% CI: 70-94] vs. 83% [95% CI: 73-93], p = 0.70).

Sex did not influence short-term postoperative functional outcome, QoL, or survival. Both sexes improved, with only a brief early QoL advantage in men. These findings indicate that sex should not guide expectations, as men and women benefit equally from LVRS.