Heterogeneity of lung volume reduction surgery outcomes in patients selected by use of evidence-based criteria

Matthew R. Lammi, Nathaniel Marchetti, Shari Barnett, Gerard J. Criner

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1905-1911
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number6
StatePublished - Jun 2013
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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