title: Comparison of open and thoracoscopic bilateral volume reduction surgery: complications analysis.
abstract: BACKGROUND
  The effectiveness of lung volume reduction for the treatment of patients with emphysema is well established, but data about the surgical approach, the postoperative management, and complications are limited. We report a comparison of patients undergoing bilateral lung volume reduction (BLVRS) via median sternotomy and thoracoscopic techniques with emphasis on hospital course and complications.
  
  
  METHODS
  All patients undergoing BLVRS at Hospital of University of Pennsylvania were analyzed for mortality and morbidity, using a combination of prospective data analysis and retrospective chart review.
  
  
  RESULTS
  Patients undergoing BLVRS via median sternotomy were older than those undergoing video-assisted thoracoscopic surgery (VATS) procedures (63.9+/-6.89 vs 59.3+/-9.4 years, p = 0.005). Operating time was longer for the VATS procedure (147 versus 129 minutes, p = 0.006) while estimated blood less was greater for median sternotomy (209 versus 82 L, p = 0.0000017). Significant differences were found in intensive care unit stay, days intubated, life-threatening complications, respiratory complications, requirement for tracheostomy, and death that favored VATS BLVRS. When only later cohorts of patients were compared, more life-threatening complications and deaths were found in patients undergoing BLVRS by median sternotomy. There were no differences between early and late median sternotomy BLVRS patients. Twenty-six percent of the lethal complications in median sternotomy BLVRS patients were bowel perforations, equally divided between duodenal ulcers and colons.
  
  
  CONCLUSIONS
  Managing patients after BLVRS remains complex. Bilateral video-assisted volume reduction offers equivalent functional outcome with potentially decreased morbidity and mortality. Gastrointestinal perforations can complicate the management of these patients.
authors.affiliation: Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA. bob.roberts@mcmail.vanderbilt.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Roberts
authors.forename: J E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: P
authors.initials: P
authors.lastname: Wahl
authors.forename: A
authors.initials: A
authors.lastname: Wurster
authors.forename: J S
authors.initials: JS
authors.lastname: Friedberg
authors.forename: L R
authors.initials: LR
authors.lastname: Kaiser
mesh_terms: D016063:Blood Loss, Surgical; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D013906:Thoracoscopy; D014140:Tracheotomy; D014741:Video Recording