Emphysema, a form of chronic obstructive pulmonary disease (COPD), is a lung disease in which the walls that separate the lung’s tiny air sacs (alveoli) are damaged.
This damage results in the lungs losing their normal elasticity. Without the ability to expand and contract with each breath, the lungs become flaccid and loose, increasingly unable to move air in and out or properly exchange oxygen and carbon dioxide between the air and blood. As the lungs become overly inflated, even the smallest physical exertion becomes difficult.
Emphysema is a major health concern worldwide. In the United States alone, it affects nearly 3.1 million people, with associated costs of over $2.5 billion annually. COPD is the third leading cause of death in the US and accounts for 125,000 deaths every year .In general, it is a condition of later life, with almost 95% of sufferers over the age of 45
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What causes emphysema?
Smoking is responsible for 90 percent of emphysema.
What is the surgery currently performed at the SIU School of Medicine on emphysema patients?
The surgery is called Lung Volume Reduction Surgery. SIU School of Medicine partners with Memorial Medical Center (MMC) offering one of five Joint Commision certified programs in the United States. The goal of this procedure is to reduce the size of the lung so that the diaphragm can relax again and be able to move up and down with breathing. This allows compressed lung tissue to re-expand so less air is trapped and high negative pressures, which cause the airways to collapse, can be reduced.
The procedure requires either an incision down the middle of the chest like that used for open heart surgery or three or four one-half inch incisions on the back side of the chest. The type of incision depends on the type of emphysema. Patients are put to sleep and the surgery takes about two hours.
A stapler is used to staple off and remove diseased air sacs. A chest tube is also inserted and remains in place for several days after the surgery is performed. This tube is the primary determinant of how long patients remain in the hospital.
How long must a patient be in the hospital?
After the surgery is complete, patients are sent to the intensive care unit overnight and then to a regular hospital bed for about 10 days. The length of the hospital stay is determined by how well the lungs seal off tiny air leaks caused by the surgery. Air leaks are monitored by the chest tube that is left in after surgery until the air leaks seal. Once leaks have sealed, the tube is taken out and most patients go home shortly after that. While patients are recovering in the hospital, they are able and encouraged to walk and perform some rehabilitative exercises even with the chest tube inserted
What are the risks for this type of surgery?
Anyone who undergoes any type of surgery is at some risk, and patients with emphysema are at more risk due to their lung condition.
After surgery, they are at a greater risk of pneumonia than patients without emphysema. It is believed there is about a five to eight percent risk of complications.
Who qualifies for the surgery?
There is an evaluation process that includes medical tests and clinic appointments. The Lung Volume Reduction Surgery Team at SIU and MMC ultimately determine the patient's eligibility.
What is expected of patients after being discharged from the hospital?
After discharge, patients are strongly encouraged to continue participating in an exercise program. This assists patients in obtaining the maximum benefit from their surgery. We expect patients to continue making improvement in their breathing about 6 months after surgery. The SIU staff also requests that patients allow their progress to be monitored at one month, six months, one year and annually after their surgery.
Is this procedure covered by insurance?
Medicare covers this procedure at the Joint Commision certified centers. Most insurance companies cover the procedure; however, the SIU staff can help patients obtain pre-admission authorization from their insurance carrier prior to the surgery just to be sure.
THORACOSCOPIC TREATMENT OF EMPHYSEMA
Studies the longitudinal results with patients treated with lung volume reduction surgery (LVRS) for emphysema.
VALUE OF SIX-MINUTE WALK ANALYSIS ON LVRS OUTCOME
Using a test done preoperatively (6-minute walk test) we will attempt to audit the risk for complications.
Procedure for Emphysema and COPD
Video courtesy of Memorial Medical Center