HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Keith S. Naunheim Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Naunheim, K. S. Search for Related Content PubMed Articles by Naunheim, K. S. Related Collections Related Article

J Thorac Cardiovasc Surg 2004;127:631-632
© 2004 The American Association for Thoracic Surgery

Editorial

Criteria for lung volume reduction surgery reimbursement: too many questions, not enough answers

^a Department of Thoracic Surgery, St Louis University, St Louis, Mo, USA

Received for publication October 31, 2003; revisions received November 3, 2003; accepted for publication November 20, 2003.

^* Address for reprints: K. S. Naunheim, MD, Department of Thoracic Surgery, St Louis University, St Louis, MO 63110, USA
naunheim@slu.edu

The first 20% of the full text of this article appears below.

See related article on page 829.

 

The report by Meyers and colleagues¹ in this edition of the Journal regarding lung volume reduction surgery (LVRS) in high-risk patients raises some interesting methodologic and ethical questions. The article was designed to assess the validity of patient selection criteria outlined in the first clinical publication of the National Emphysema Treatment Trial (NETT).² In that article, NETT investigators identified a high-risk patient subset characterized by the combination of a forced expiratory volume in 1 second (FEV₁) less than or equal to 20% of predicted and either a homogeneous pattern of disease or a diffusing lung capacity for carbon monoxide (DLCO) less than or equal to 20% of predicted. This subgroup experienced a high mortality and morbidity that outweighed the clinical benefit from the procedure. The report herein disputes this conclusion by demonstrating that patients with an FEV₁ less than or equal to 20% and a DLCO less than or equal to 20% but who have a heterogeneous pattern of disease can benefit from LVRS. The argument goes that such patients should not be prevented from undergoing LVRS, as has been specified in the recent Medicare coverage decision, which used the NETT results as a guideline for reimbursement.

Therefore, the NETT suggests that a specific subset of patients constitute a high-risk group that should not undergo LVRS, . . . [Full Text of this Article]

Related Article

Results of lung volume reduction surgery in patients meeting a National Emphysema Treatment Trial high-risk criterion

Bryan F. Meyers, Roger D. Yusen, Tracey J. Guthrie, G. Alexander Patterson, Stephen S. Lefrak, Gail E. Davis, and Joel D. Cooper
J. Thorac. Cardiovasc. Surg. 2004 127: 829-835. [Abstract] [Full Text] [PDF]