Mortality and functional performance in severe emphysema after lung volume reduction or transplant.
The purpose of this endeavor is to compare the morbidity, mortality and costs of LVRS versus transplantation in severe emphysema. This was a retrospective review of severe emphysema patients who received LVRS (n = 70) from 1994-1999, or transplant (n = 87) from 1994-2004. Change in functional status was calculated by the change in modified BODE (mBODE) score. Financial data included physician, hospital and medication costs. Preoperatively, there was no significant difference between the transplant and LVRS groups (mean +/- SD) in age (57.7 +/- 5.7 vs. 59.1 +/- 8.3 years), BMI, Borg dyspnea score, 6-minute walk distance or mBODE (10.4 +/- 2.6 vs. 9.6 +/- 2.7, p = 0.4). Preoperatively, FEV1% (23.6 +/- 8.5 vs. 31.9 +/- 17.7, p = 0.008) was significantly lower in the transplant group. One year post-operatively, transplantation patients had a significantly greater improvement in mBODE (-5.7 vs. -2.0, p = 0.0004), FEV1% (43.4 vs. 2.2%, p = 0.0004) and Borg score (-3.0 vs. -1.4, p = 0.04). Transplantation patients had lower long-term survival compared to LVRS patients (p = 0.01). The only variable that affected survival was type of surgery favoring LVRS (hazard ratio 1.7, 95% confidence limits 1.05-2.77). During a mean follow-up of 2.4 +/- 2.5 years after transplant and 5.0 +/- 3.1 years after LVRS, transplantation mean total costs were greater ($381,732 vs. $140,637, p < 0.0001). Transplantation patients spent more time in the hospital (74.3 +/- 81.3 vs. 39.5 +/- 66.7 days, p = 0.009) and had more outpatient visits (29.9 +/- 28.8 vs. 12.3 +/- 12.6 visits, p < 0.0001). In patients who survive over 1 year, transplantation provides a higher level of functional status and a greater improvement in airflow obstruction, dyspnea, exercise tolerance, and mBODE score, but costs more and carries greater mortality.
Weinstein
Michael S
MS
Divisions of Pulmonary and Critical Care Medicine and Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA. michaelweinstein@comcast.net
Martin
Ubaldo J
UJ
Crookshank
Aaron D
AD
Chatila
Wissam
W
Vance
Gwendolyn B
GB
Gaughan
John P
JP
Furukawa
Satoshi
S
Criner
Gerard J
GJ
D000704:Analysis of Variance; D003365:Costs and Cost Analysis; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016040:Lung Transplantation / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015143:Philadelphia; D011013:Pneumonectomy / Q000191:economics / Q000401:mortality; D011656:Pulmonary Emphysema / Q000191:economics / Q000401:mortality* / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome