title: Heterogeneity of lung volume reduction surgery outcomes in patients selected by use of evidence-based criteria.
abstract: BACKGROUND
  Despite its benefit, lung volume reduction surgery (LVRS) is underused, partially because of the heterogeneous responses and lack of recent outcomes data.
  
  
  METHODS
  Data from 59 consecutive emphysema patients who underwent LVRS were analyzed. The proportion of patients responding based on 6-minute walk distance (6-MWD), exercise capacity (watts), and forced expiratory volume in 1 second (FEV1) were calculated. Baseline variables were correlated with improvements in 6-MWD, maximal watts, and FEV1.
  
  
  RESULTS
  Eighty-eight percent of patients responded to LVRS, with a higher proportion of FEV1 and 6-MWD responders in our cohort compared with similar patients from the National Emphysema Treatment Trial. Significant associations existed between lower baseline 6-MWD and increased 6-MWD after operation (r = -0.423), more extensive emphysema and increased FEV1 (r = 0.491), and hyperinflation and increased maximal watts (r = 0.438). The probability of survival was 0.93 at 90 days, 0.90 at 1 year, and 0.80 (3 years). The lowest exercise group (<20 watts on baseline testing) had an increased risk for death (RR 13.3, p = 0.001).
  
  
  CONCLUSIONS
  There were durable improvements in FEV1 and exercise capacity in patients meeting the National Emphysema Treatment Trial criteria. Survival was comparable to that in similar patients from the National Emphysema Treatment Trial; response rates were higher in our cohort for FEV1 and 6-MWD. Those with lower 6-MWD, more emphysema, and more hyperinflation at baseline were most likely to respond to LVRS. Those with lowest exercise capacity at baseline may have a higher risk of death after LVRS.
authors: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. mlammi@lsuhsc.edu
authors: Matthew R
authors: MR
authors: Lammi
authors: Nathaniel
authors: N
authors: Marchetti
authors: Shari
authors: S
authors: Barnett
authors: Gerard J
authors: GJ
authors: Criner
mesh_terms: D000368:Aged; D019317:Evidence-Based Medicine; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011182:Postoperative Care / Q000379:methods; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D011788:Quality of Life; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D014109:Total Lung Capacity / Q000502:physiology*; D016896:Treatment Outcome