Methodology Surgical interventions for emphysema have become more accessible in the last few years.1 We have reviewed the referral rate and outcomes from our community based COPD service to a tertiary surgical centre. Our COPD service includes a respiratory consultant and nurse specialist and has access to secondary care respiratory investigations such as HRCT and pulmonary function testing.
Results During the period April 2013–March 2015 202 new referrals were made to the consultant led clinic of which 181 were subsequently diagnosed with COPD. 10 referrals for consideration of surgical intervention were made, a referral rate of 6%. The referral rate from the same consultants secondary care clinic during this period was 8% (10 referrals from 126 new COPD patients).
Referred patients had a mean age of 60 years (range 45–72), mean COPD Assessment Test (CAT) score 19 (8–32), mean FEV1 38% predicted (22–64%) and mean RV 196% (163–246%).
All referred patients are discussed at a regional COPD MDT. 5 patients have subsequently received an intervention- 2 lung volume reduction surgery and 3 endobronchial valve placement. 2 patients declined further assessment following discussion with surgeons. 3 patients currently undegoing further investigation to assess operative risk. Outcomes from secondary care referrals were similar (3 had an intervention, 5 were declined and 2 awaiting further assessment).
Post operative CAT scores improved by an average of 9 points. Uncomplicated recovery is rare with complications ranging from wound infection to coughing up a valve. Patients felt the information given pre-operatively by the community and surgical services was at the right level, although it was noted by the community respiratory nurse that patients required significant psychological support before and after surgery.
Summary Management of complex emphysema is possible in a community setting. 6% of COPD patients were referred for assessment for surgical intervention for their emphysema. Objective and subjective patient reported outcome measures improved post operatively. Patients needed more intensive support from the community team in the peri- and post-operative periods.
Reference 1 Zoumot, et al. Emphysema: time to say farewell to therapeutic nihilism. Thorax 2014;69:973–5