Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Lung Excision


Related Terms

  • Lobectomy
  • Partial Lobectomy
  • Pneumonectomy
  • Segmental Resection
  • Total Lobectomy
  • Wedge Resection

Specialists

  • Pulmonologist
  • Thoracic Surgeon

Comorbid Conditions

Factors Influencing Duration

The stage of the disease that necessitates lung excision when first diagnosed, the individual's age and general health, the type of tumor, and its growth rate are factors that influence disability. Previous lung surgery also affects disability.

Following lung surgery, disability factors include the number and severity of postoperative complications (i.e., wound infections, bleeding, pneumonia, respiratory insufficiency, or an adverse reaction to a general anesthetic); the amount of blood lost during surgery and postoperatively; the number of blood transfusions required; the individual's nutritional status, mental and emotional stability, and access to rehabilitation facilities; and the strength of the individual's support system.

Medical Codes

ICD-9-CM:
32.28 - Endoscopic Excision or Destruction of Lesion or Tissue of Lung
32.29 - Excision or Destruction of Lesion or Tissue of Lung, Other; Resection of Lung, NOS; Wedge Resection of Lung
32.30 - Thoracoscopic Segmental Resection of Lung
32.39 - Thoracoscopic Segmental Resection of Lung, Other and Unspecified
32.41 - Thoracoscopic Lobectomy of Lung
32.49 - Lobectomy of Lung, Other
32.50 - Thoracoscopic Pneumonectomy
32.59 - Pneumonectomy, Other and Unspecified

Overview

Lung excision is the surgical removal (excision) of all or part of the lung. Pneumonectomy is excision of the entire lung. Lobectomy is excision of one or more sections (lobes) of the lung. Segmental resection is removal of one or more sections (segment) of a lobe. Wedge resection is excision of a triangular portion of a lung across more than one segment.

Most lung excisions are done to treat non-small-cell lung cancer (NSCLC). Lung excisions are also done when an individual sustains a major wound to the chest with extensive bleeding, if the bronchial tube carrying air into the lung is damaged beyond repair, for recurrent pneumonia, for persistent bleeding that fails to respond to conventional management, for suspicious nodules where a diagnosis is not clear, and for diffuse lung disease to obtain a tissue sample for diagnosis.

Source: Medical Disability Advisor



Reason for Procedure

Excision of the entire lung (pneumonectomy) is most commonly performed to remove cancer originating in the lung (primary lung cancer) that cannot be removed with a lobectomy, segmental resection, or wedge resection. Other diseases and conditions treated with pneumonectomy include chronic dilation of the airways within the lung as a result of infection (chronic bronchiectasis) and multiple abscesses of the lung. Before a decision is made to remove a lung, pulmonary function tests are performed on the remaining lung to ensure it is healthy enough to cope with increased demands.

Excision of one or more sections or lobes of the lung (lobectomy) is most commonly performed to remove cancer that is confined to a particular lobe. Other diseases and conditions treated with lobectomy include bronchiectasis, giant blisters (blebs or bullae) associated with bullous emphysema, noncancerous (benign) tumors confined to the lobe, fungal infections, and congenital abnormalities.

Segmental resection is most commonly performed to remove lung tissue damaged by bronchiectasis or chronic inflammation. During a segmental resection, only the segment of lung containing the diseased tissue is removed. Healthy segments are preserved.

Wedge resection is most commonly performed to remove small, benign, primary lung tumors, treat localized inflammatory disease, and remove tissue for diagnostic biopsy.

Source: Medical Disability Advisor



How Procedure is Performed

Pneumonectomy, lobectomy, and segmental resection, procedures approach the lungs from the side through a thoracotomy incision. In some cases, the surgeon may choose to approach the lungs from the front through the breastbone (median sternotomy incision), but this is much less common. Wedge resection, particularly for diagnostic biopsies, may be done using thoracoscopy, which is a less invasive procedure.

For a thoracotomy, the individual is at first positioned on the back (supine position) and secured to the table with a safety belt across the upper thighs. Monitoring equipment is secured (temperature probe, ECG leads, and a pulse oximeter finger cot to measure the level of oxygen in the blood). Intravenous lines are inserted for administration of fluids, medications, and blood during and after surgery. A special line to monitor arterial blood gases (oxygen and carbon dioxide) may be inserted. General anesthesia is induced, and a breathing tube (endotracheal tube) is placed through the mouth and into the windpipe (trachea) to maintain an airway during surgery.

After being anesthetized, the individual is repositioned onto the nonoperable side (lateral or semilateral position). Arms are secured and bony prominences (hip, ankle, elbow, shoulder) are padded to prevent pressure sores. A catheter may be inserted into the spine to deliver pain medication postoperatively (epidural analgesia). Compression stockings may be applied to keep an even flow of blood moving through the legs during surgery and to prevent formation of clots. A urinary catheter may be inserted into the bladder with the tubing hooked to a drainage bag in order to monitor kidney (renal) function during surgery. A nasogastric tube may be passed through the nose and into the stomach to drain accumulated stomach secretions. A conduction pad may be secured on the thigh to prevent burns when blood vessels are cauterized with the electrocautery machine.

The surgical area, including the entire rib cage on the surgical side from the middle of the back to the middle of the chest and stomach and from the neck to below the hip, is washed (prepped) with an antibacterial solution. The individual is covered with sterile, moisture-proof surgical drapes, leaving the surgical area exposed (the entire rib cage on the surgical side). The head portion of the drape is lifted off the individual's face and fastened to a canopy so that the entire head and neck are protected from the surgical field but exposed to the anesthesiologist. A sterile plastic adhesive drape is placed over the exposed surgical field.

The surgeon cuts (incises) the individual's skin, underlying tissue, and muscle, usually between the fourth and fifth ribs. A rib may be removed to provide a better view. The ribs are separated with a rib retractor. The retractor is slowly cranked open, separating the ribs and exposing the diseased lung. The surgeon uses scissors to open the membrane that surrounds the lung (the pleura) and gently peels it away from the lung.

For a pneumonectomy, all branches of the main blood vessels entering and leaving the diseased lung (pulmonary artery and vein) are clamped, tied twice with nonabsorbable suture, and cut in two (divided). The main air tube (bronchus) going from the windpipe (trachea) to the diseased lung is clamped and divided. The lung is removed from the chest. A piece of pleura may be used to cover the bronchus stump. The bronchus stump is then closed with nonabsorbable suture. The chest cavity is irrigated with sterile salt water (saline) to check for leaks in the bronchus stump and to clear the chest of old blood. Bleeding is controlled with sutures and electrocautery.

A lobectomy is performed in a similar way. The bronchus is clamped and divided above the lobe or lobes to be removed. The bronchus stump is closed as previously described. The edges of the remaining lung are sutured together, and the lung is re-inflated. The chest cavity is irrigated with saline to check for leaks in the suture line of the remaining lung and to clear the chest of old blood. At this time, the surgeon also assesses the degree of expansion the remaining lung can provide. Bleeding is controlled with sutures and electrocautery.

A segmental resection procedure is performed much like a lobectomy, with only a segment of a lobe being removed rather than the whole lobe. Blood vessels supplying the segment are clamped and tied with nonabsorbable suture and divided. The segment of bronchus supplying the segment is clamped, divided, and closed in the usual manner. The edges of lung are sutured together, and bleeding is controlled. A wedge resection is very similar to a segmental resection, but the portion of lung removed comes from more than one lobe segment.

Chest tubes are not inserted after pneumonectomy. Following pneumonectomy, the chest cavity is allowed to fill with air and fluid. The levels are monitored, with just enough pressure placed on the heart and other lung to keep them in their normal space without obstructing them or letting them drift to the empty side. Chest tubes are inserted after lobectomy, segmental resection, and wedge resection. Chest tubes are inserted through the skin and into the space around the lung (the pleural space). The other ends of the chest tubes are attached to sealed drainage systems that allow blood to drain from the pleural cavity while not allowing air back in. The tubes are secured to the skin with sutures.

During closure, the muscle and each layer of tissue are closed with surgical sutures. The skin is closed with sutures and the suture line covered with a thin layer of sterile gauze and secured with tape. The individual may transfer directly to the intensive care unit, rather than the recovery room, for recovery from anesthesia.

Wedge resection can now be performed using a scope, much like a laparoscopic procedure. This is called a video-assisted thoracoscopic surgery (VATS). It is set up much the same as a standard wedge resection, except three small incisions are made in the chest wall. Instruments are inserted into the chest cavity, and a video camera helps to guide their use. Following the procedure, a chest tube is often left in place for a few hours. This procedure works best when only a small amount of tissue needs to be removed.

Source: Medical Disability Advisor



Prognosis

The prognosis following partial removal of a lung depends on the underlying disease or condition requiring surgery. Individuals with lungs diseased from emphysema, infection, or other conditions have reduced lung capacity before surgery. Removing part of the lung reduces this capacity even more. In general, the less of a lung removed, the better the outcome for the individual in terms of returning to work and performing activities of daily living.

The prognosis following pneumonectomy for lung cancer is poor. If lung cancer is found early, before it has spread to nodes or other organs, the 5-year survival rate following surgery is 49% ("Detailed Guide"). However, lung cancer is rarely diagnosed in the very early stages when lung excision is most beneficial. As a result, the 5-year survival rate for all stages of lung cancer combined is only 15% ("Detailed Guide").

Source: Medical Disability Advisor



Rehabilitation

Individuals who undergo the excision of one or more lobes of the lungs require occupational, physical, and respiratory therapy after surgery. All therapies begin in the hospital, and occupational and physical therapy continues after discharge.

Respiratory therapy aims to increase lung capacity and decreased the risk of a buildup of lung secretions. Respiratory therapists teach individuals pursed-lip breathing to increase the airflow to the lungs. Individuals may also use an incentive spirometer. This device measures and displays the amount of air inspired to help motivate individuals to take deeper breaths. Individuals also learn to produce an effective cough and are taught which positions may help relieve shortness of breath.

Occupational therapy addresses any fatigue or shortness of breath that may occur during activities of daily living. Occupational therapists may teach energy conservation techniques, in which activities such as meal preparation are broken into smaller components to make tasks more manageable. Therapists may also teach individuals to use equipment that conserves energy.

Physical therapy addresses decreased endurance, strength, and range of motion. Individuals learn to stretch the shoulder and chest muscles on the side of the removed lung to help normalize posture. Individuals perform strengthening exercises to improve overall endurance and promote normal posture. They may perform aerobic activity such as walking on a treadmill or riding a stationary bicycle to further increase endurance. Individuals learn to rate the amount of energy they expend by utilizing a rating of perceived exertion scale. This is a numbered scale that rates exercises from "very, very light" to "very, very hard." Individuals use this scale to stay within safe exercise parameters predetermined by their physicians.

Source: Medical Disability Advisor



Complications

Complications following lung surgery include collapsed lung (atelectasis), heart rhythm disturbances, air leakage from the bronchial stump (pneumothorax), hemorrhage, shifting of organs and tissue into the space formerly filled by the removed lung or lobe (mediastinal shift), lung infection (pneumonia), accumulation of excess fluid in the space formerly filled by the removed lung or lobe (pleural effusion), respiratory insufficiency, respiratory failure, and death.

A ruptured bronchial stump requires immediate surgery, as does hemorrhage caused by slippage of a suture from one of the major pulmonary vessels that were cut and sutured during lung surgery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

After the individual returns to work, work hours may be gradually increased over several weeks until individual is working a full shift, if possible. Many individuals who have had all or part of a lung removed may experience some degree of shortness of breath, even without exertion. These individuals most likely require work restrictions and accommodations that help conserve energy and reduce the requirement for oxygen.

Other medical problems or permanent disabilities because of underlying medical conditions, such as diabetes, chronic renal failure requiring dialysis, or chronic heart disease or postoperative complications, may also require work restrictions and accommodations.

Source: Medical Disability Advisor



References

Cited

"Detailed Guide: Lung Cancer." American Cancer Society. 15 Sep. 2004 <http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=26>.

Source: Medical Disability Advisor






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