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Keith S. Naunheim
Douglas E. Wood
Mark J. Krasna
Malcolm M. DeCamp, Jr
Mark E. Ginsburg
Robert J. McKenna, Jr
Claude Deschamps
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J Thorac Cardiovasc Surg 2006;131:43-53
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

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

Keith S. Naunheim, MD a , * , Douglas E. Wood, MD b , Mark J. Krasna, MD c , Malcolm M. DeCamp, Jr, MD d , Mark E. Ginsburg, MD e , Robert J. McKenna, Jr, MD f , Gerard J. Criner, MD g , Eric A. Hoffman, PhD h , Alice L. Sternberg, ScM i , Claude Deschamps, MD j National Emphysema Treatment Trial Research Group

a Division of Cardiothoracic Surgery, St Louis University Health Sciences Center, St Louis, Mo
b University of Washington, and the Cost-Effectiveness Data Center, Fred Hutchinson Cancer Research Center, Seattle, Wash
c University of Maryland at Baltimore and Johns Hopkins Hospital, Baltimore, Md
d Cleveland Clinic Foundation, Cleveland, Ohio
e Columbia University, New York, and Long Island Jewish Medical Center, New Hyde Park, NY
f Cedars-Sinai Medical Center, Los Angeles, Calif
g Temple University Medical Center, Philadelphia, Pa
h CT Scan Image Storage and Analysis Center, University of Iowa, Iowa City, Iowa
i Coordinating Center, Johns Hopkins University, Baltimore, Md
j Mayo Foundation, Rochester, Minn.

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 12, 2005; revisions received September 4, 2005; accepted for publication September 9, 2005.

* Address for reprints: Keith S. Naunheim, MD, Division of Cardiothoracic Surgery, St Louis University Health Sciences Center, 3635 Vista Ave, St Louis, MO 63110-0250. (Email: naunheim{at}slu.edu).

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:


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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.

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




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