General thoracic surgery
Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.
https://doi.org/10.1016/j.jtcvs.2005.09.006Get rights and content
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Objective

We sought to identify predictors of operative mortality, pulmonary morbidity, and cardiovascular morbidity after lung volume reduction surgery.

Methods

Univariate and multivariate logistic regression analyses were performed. Candidate predictors included demographic characteristics, physical condition characteristics, pulmonary function measures, measures of the distribution of emphysema as determined by radiologists and by means of computerized analysis of chest computed tomographic scans, and measures of exercise capacity, dyspnea, and quality of life. End points analyzed were operative mortality (death within 90 days of the operation), major pulmonary morbidities (tracheostomy, failure to wean, reintubation, pneumonia, and ventilator for ≥3 days), and cardiovascular morbidities (infarction, pulmonary embolus, or arrhythmia requiring treatment).

Results

Five hundred eleven patients in the non–high-risk group of the National Emphysema Treatment Trial underwent lung volume reduction. The incidence of operative mortality was 5.5%, major pulmonary morbidity occurred in 29.8% of patients, and cardiovascular morbidity occurred in 20.0% of patients. Predictors for these end points are as follows:

Empty CellEmpty CellRelative oddsP value
Operative mortalityNon–upper-lobe predominance (radiologist)2.99.009
Pulmonary morbidityAge in years1.05.02
FEV1 % predicted0.97.05
Dlco % predicted0.97.01
Cardiovascular morbidityAge in years1.07.004
Oral steroid use1.72.04
Non–upper-lobe predominance (QIA α measure)2.67<.001

FEV1, Forced expiratory volume in 1 second; Dlco, diffusion capacity; QIA, quantitative image analysis.

Conclusions

Although lung volume reduction can be performed in selected patients with acceptable mortality, the incidence of major cardiopulmonary morbidity remains high. The lone predictor for operative mortality of lung volume reduction was the presence of non–upper-lobe-predominant emphysema, as assessed by the radiologist. Pulmonary morbidity can be expected in elderly patients who have a low diffusing capacity for carbon monoxide and forced expiratory volume in 1 second. When assessing morbidity, the computer-assisted chest computed tomographic analysis proved useful only in predicting cardiovascular complications.

CTSNet classification

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Abbreviations and Acronyms

CT
computed tomography
Dlco
diffusing capacity for carbon monoxide
FEV1
forced expiratory volume in 1 second
HU
Hounsfield unit
LVRS
lung volume reduction surgery
NETT
National Emphysema Treatment Trial
QIA
quantitative image analysis
RO
relative odds
UCSD
University of California San Diego

Cited by (0)

The National Emphysema Treatment Trial is supported by the National Heart, Lung, and Blood Institute (contracts N01HR76101, N01HR76102, N01HR76103, N01HR76104, N01HR76105, N01HR76106, N01HR76107, N01HR76108, N01HR76109, N01HR76110, N01HR76111, N01HR76112, N01HR76113, N01HR76114, N01HR76115, N01HR76116, N01HR76118, and N01HR76119); the Centers for Medicare and Medicaid Services; and the Agency for Healthcare Research and Quality.