Comparative results of nonresectional LVRS by awake or nonawake anesthesia

OBJECTIVE. In a prospective nonrandomized study, we compared results and costs of nonresectional lung volume reduction surgery (LVRS) performed through awake or nonawake anesthesia that was liberally chosen by recruited patients METHOD. Nonresectional LVRS was performed by epidural anesthesia in 41 patients (awake group ) and by general anesthesia in 19 patients (nonawake group). Perioperative outcome included analysis of oxygenation (PaO2/FiO2) 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 one (FEV1), Plethysmographic residual volume (RVplet) and maximal incremental treadmill test (MITT) score were assessed preoperatively and every 6 months postoperatively. RESULTS. 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 nonawake group (7800 euros vs 8600 euros, P=0.006). At 6 months there was no difference (awake vs nonawake) 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). CONCLUSION. In our study, awake nonresectional 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 nonawake anesthesia. Six months’ clinical results were comparable showing that the awake approach had no impact on late clinical benefit.