HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Keith S. Naunheim Larry R. Kaiser Robert J. Keenan Joseph E. Bavaria Rodney J. Landreneau Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Naunheim, K. S. Articles by Keller, C. A. Search for Related Content PubMed PubMed Citation Articles by Naunheim, K. S. Articles by Keller, C. A.

Eur J Cardiothorac Surg 2000;17:673-679
© 2000 Elsevier Science NL

Risk analysis for thoracoscopic lung volume reduction: a multi-institutional experience

^a Saint Louis University, Cardio-thoracic Surgery and Pulmonology Divisions, St. Louis, MO, USA
^b Southern Illinois University, Cardio-thoracic Surgery Division, Springfield, IL, USA
^c University of Pennsylvania, Cardio-thoracic Surgery Division, Philadelphia, PA, USA
^d University of Pittsburgh, Cardio-thoracic Surgery Division, Pittsburgh, PA, USA
^e Allegheny University, Cardio-thoracic Surgery Division, Pittsburgh, PA, USA

Corresponding author. Department of Surgery, Saint Louis University Health Sciences Center, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110-0250, USA. Tel.: +1-314-577-8360; fax: +1-314-577-8315
e-mail: naunheim{at}slu.edu

Objective: Most reports of thoracoscopic lung volume reduction (TLVR) are relatively small and early experiences from a single institution, factors which limit both the statistical validity and the applicability to the population at large. In order to address these shortcomings we undertook an analysis of the TLVR experience at five separate institutions to assess operative morbidity and identify predictors of mortality. Methods: Questionnaires were sent to four groups of surgical investigators at five institutions actively performing TLVR. Data was requested regarding preoperative, operative and postoperative parameters. Twenty-five potential predictors of mortality were analyzed and seven proved to be at least marginally significant (P<0.10). These parameters were entered into a stepwise logistic regression analysis to identify independent predictors. Results: The 682 patients (415 males, 267 females, mean age 64.0 years) underwent unilateral (410) or bilateral (272) TLVRs. Overall, operative mortality was 6% with half of the deaths resulting from respiratory causes. The remaining patients were discharged to home (88%), a rehabilitation facility (4%) or a ventilator facility (2%). There were 25 perioperative factors chosen representing clinically important indices such as spirometry, oxygenation, functional status, clinical and demographic variables. Univariate analysis identified seven variables as predictors of mortality (P<0.10) and these were entered into a stepwise logistic regression analysis. Only age, 6-min walk, gender (male 8%, female 3% mortality) and the procedure performed (unilateral 4.6%, bilateral 8%) were independent predictors while preoperative steroid therapy, preoperative oxygen administration, and time since smoking cessation dropped out of the model. The specific institution, learning curve (early vs. late experience), type of lung disease, spirometric indices and predicted maximum VO₂ were not significant predictors. Conclusion: This experience suggests that unilateral and bilateral lung volume reduction procedure can be performed with acceptable morbidity and mortality. Although age, gender, exercise capacity and the procedure performed are all independent predictors of mortality, the risk of operative death did not appear excessive in this fragile patient subset.

Key Words: Lung volume reduction • Pulmonary emphysema • Postoperative complications • Emphysema • Treatment outcome

This article has been cited by other articles:

				N. W. Brister, R. E. Barnette, V. Kim, and M. Keresztury Anesthetic Considerations in Candidates for Lung Volume Reduction Surgery Proceedings of the ATS, May 1, 2008; 5(4): 432 - 437. [Abstract] [Full Text] [PDF]

				M. M. DeCamp Jr., R. J. McKenna Jr., C. C. Deschamps, and M. J. Krasna Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity Proceedings of the ATS, May 1, 2008; 5(4): 442 - 446. [Abstract] [Full Text] [PDF]

				A. Shaw Genetics of postoperative complications following thoracic surgery. Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2006; 10(4): 327 - 345. [Abstract] [PDF]

				K. S. Naunheim, D. E. Wood, M. J. Krasna, M. M. DeCamp Jr, M. E. Ginsburg, R. J. McKenna Jr, G. J. Criner, E. A. Hoffman, A. L. Sternberg, C. Deschamps, et al. Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 43 - 53. [Abstract] [Full Text] [PDF]

				B. F. Meyers, R. D. Yusen, T. J. Guthrie, G. A. Patterson, S. S. Lefrak, G. E. Davis, and J. D. Cooper Results of lung volume reduction surgery in patients meeting a National Emphysema Treatment Trial high-risk criterion J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 829 - 835. [Abstract] [Full Text] [PDF]

				National Emphysema Treatment Trial Research Group Patients at High Risk of Death after Lung-Volume-Reduction Surgery N. Engl. J. Med., October 11, 2001; 345(15): 1075 - 1083. [Abstract] [Full Text] [PDF]

				K. R. Flaherty, E. A. Kazerooni, J. L. Curtis, M. Iannettoni, L. Lange, M. A. Schork, and F. J. Martinez Short-term and Long-term Outcomes After Bilateral Lung Volume Reduction Surgery : Prediction by Quantitative CT Chest, May 1, 2001; 119(5): 1337 - 1346. [Abstract] [Full Text] [PDF]