Postoperative Improvement After Lung Volume Reduction Surgery for Severe Emphysema is Not Affected by Sex

Introduction Lung volume reduction surgery (LVRS) is an established treatment for selected emphysema patients. Because COPD differs by sex in etiology, symptom perception, and treatment response, we examined whether these differences affect LVRS outcomes. Methods 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, BMI, 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-minutes 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. Results 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 (+57m vs. +54m; p=0.47), whereas SGRQ improved more in men (-19 vs. -11 points; p=0.020). At six 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). Conclusion 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.