SESSION TYPE: Thoracic Surgery I
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: The National Emphysema Treatment Trial established the efficacy of LVRS and defined the target patient population. Now, a decade since accrual for this landmark trial ended, the volume of LVRS performed in the United States remains remarkably low. LVRS is limited to JCHO certified sites and approved lung transplant centers which may reduce utilization but ensures rigorous monitoring of outcomes of the procedure. We reviewed the Society for Thoracic Surgery (STS) database from the year of publication of the NETT to the present to assess utilization and outcomes of the procedure.
METHODS: The general thoracic STS database was queried, identifying all patients undergoing LVRS between 2003 and 2011. Volume of procedures was assessed annually. Demographics and comorbidities were recorded. Primary outcomes evaluated were length of stay (LOS) and mortality. Secondary outcome was morbidity. Complications were recorded based on existing STS definitions. Quantitative data was recorded as mean, median, 25th and 75th quartiles.
RESULTS: A total of 585 LVRS patients were identified over a 9 year period. Yearly distribution ranged from 20-118, annual average 65 cases. Mean age was 61 (median 62), 90% were Caucasian, 45% female. Preoperative mean and median FEV1(% predicted) were 31 and 28 respectively. Mean DLCO was 37% predicted. Mean pack/year smoking history was 56 years and median 50. Morbidity was documented in 72% of patients. Pulmonary complications were numerous with prolonged air leak (60%) most common. Atrial arrhythmia (14%) was the most common non-respiratory complication. Prolonged ventilation occurred in 2.9% of patients and 6% had unexpected return to ICU. Postoperative LOS was mean 11 days and median 9 days. Mortality at discharge was 5.98% and 30-day mortality 4.79%
CONCLUSIONS: STS database review confirms that though LVRS volume has increased modestly since the initial NETT data was published in NEJM; it remains an underutilized therapy for patients with severe emphysema. Patient demographics, comorbidities and physiologic parameters (FEV1, DLCO) suggest that when utilized appropriate candidates are selected. Morbidity remains high for this procedure and mortality is similar to that seen in the non-high risk candidates identified in the NETT.
CLINICAL IMPLICATIONS: LVRS volume has increased slowly and is less than expected given the prevalence of emphysema. Database review can assist in identifying trends in utilization as well as best practice information to optimize outcomes.
DISCLOSURE: The following authors have nothing to disclose: James Maloney, Nicole Strieter, Jeffrey Havlena
No Product/Research Disclosure InformationUniversity of Wisconsin, Madison, WI