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

K S Naunheim1, S R Hazelrigg, L R Kaiser

  • 1Saint Louis University, Cardio-thoracic Surgery and Pulmonology Divisions, St. Louis, MO 63110-0250, USA. naunheim@slu.edu

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|June 17, 2000
PubMed
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Multicenter analysis of thoracoscopic lung volume reduction (TLVR) in 682 patients shows acceptable operative mortality. Age, gender, exercise capacity, and procedure type predict mortality in this fragile patient group.

Area of Science:

  • Thoracic surgery
  • Pulmonary medicine
  • Critical care medicine

Background:

  • Thoracoscopic lung volume reduction (TLVR) reports are often limited by small sample sizes and single-institution experiences.
  • This restricts the statistical validity and broad applicability of findings regarding operative morbidity and mortality.
  • A multicenter analysis is crucial to overcome these limitations and provide a more comprehensive understanding of TLVR outcomes.

Purpose of the Study:

  • To assess the operative morbidity and mortality associated with thoracoscopic lung volume reduction (TLVR).
  • To identify independent predictors of mortality following TLVR across multiple institutions.
  • To evaluate the safety and efficacy of TLVR in a larger, diverse patient population.

Main Methods:

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  • A questionnaire-based data collection was distributed to surgical investigators at five institutions performing TLVR.
  • Preoperative, operative, and postoperative parameters were analyzed for 682 patients undergoing unilateral or bilateral TLVR.
  • Stepwise logistic regression was employed to identify independent predictors of mortality from 25 potential factors.

    • Main Results:

    • Overall operative mortality was 6%, with respiratory causes accounting for half of the deaths.
    • Independent predictors of mortality included age, 6-minute walk distance, gender (male higher risk), and procedure type (bilateral higher risk).
    • Factors such as institution, learning curve, lung disease type, and spirometry were not significant predictors.

    Conclusions:

    • Thoracoscopic lung volume reduction, both unilateral and bilateral, can be performed with acceptable morbidity and mortality rates.
    • While age, gender, exercise capacity, and procedure type are independent predictors of mortality, the overall risk is not excessive in this patient subset.
    • This multicenter study provides valuable insights into the safety profile and risk factors associated with TLVR, supporting its role in select patients.