Mortality and Functional Performance in Severe Emphysema after Lung Volume Reduction or Transplant

Figures & data

Table 1 Baseline characteristics

	Transplant	n	LVRS	n	p
n	87 (42 male)	87	70 (32 male)	70	0.38
Age (years)	57.7 ± 5.7	87	59.1 ± 8.3	70	0.28
mBODE	10.4 ± 2.6	66	9.6 ± 2.7	62	0.40
FEV1 (%)	23.6 ± 8.5	66	31.9 ± 17.7	62	0.008
6MWD (m)	257.9 ± 119.1	66	285.2 ± 97.3	62	0.49
Borg	5.9 ± 2.1	66	5.6 ± 2.0	62	> 0.99
BMI (kg/m^2)	24.2 ± 4.1	66	24.3 ± 4.6	62	> 0.99
CI (l/min/m^2)	2.9 ± 0.8	70	2.7 ± 0.5	28	> 0.99
Mean PAP (mmHg)	23.1 ± 7.0	70	23.2 ± 6.7	28	> 0.99
EF (%)	53.1 ± 12.5	83	53.9 ± 9.7	67	> 0.99

Definition of Abbreviations: mBODE—composite index of BMI, Airflow Obstruction, Dyspnea, and Exercise Capacity, FEV₁—Forced Expiratory Volume in 1 second, 6MWT—6-minute walk test, Borg—Borg dyspnea scale, BMI—body mass index, CI—cardiac index, PAP—pulmonary artery pressure, EF—ejection fraction.

Figure 1 Kaplan–Meier analysis showing that survival is greater following LVRS than following transplantation (p = 0.01) by the log-rank test.

Table 2 1-year postoperative data of surviving patients

	LVRS	p compared to baseline	Transplant	p compared to baseline	p LVRS compared to Transplant
BMI (kg/m^2)	24.5 ± 4.4	0.99	26.3 ± 4.4	0.0004	0.42
FEV1 (%)	34.1 ± 15.1	0.03	67.0 ± 24.2	0.0004	0.0004
6MWD (m)	323.3 ± 100.9	0.057	327.6 ± 119.1	0.0004	0.49
Borg	4.2 ± 2.4	0.002	2.9 ± 2.6	0.0004	0.04
mBODE	7.6 ± 3.3	0.002	4.7 ± 3.7	0.0004	0.0004

Figure 2 Compares the changes in FEV₁, 6-minute walk test, mBODE and Borg from before surgery to 1-year post-surgery between LVRS patients (shown on the left) and transplantation patients (shown on the right). More transplantation patients are missing or dead at 1-year (below dotted line), while more LVRS patients did not improve following surgery (also below dotted line). Of patients who survived 1 year post-surgery, the transplantation patients had greater improvements in functional status (above dotted line).

Table 3 Secondary outcomes

n	Transplant 79	LVRS 57	p
Surgery Length of Stay (days)	35.6 ± 45.0	24.4 ± 44.8	0.08
Total Inpatient Days	74.3 ± 81.3	39.5 ± 66.7	0.009
Hospitalizations	3.9 ± 3.4	2.3 ± 2.7	0.003
Outpatient Visits	29.9 ± 28.8	12.3 ± 12.6	< 0.0001
Same Day Procedures	3.3 ± 3.0	0.1 ± 0.4	< 0.0001
Physician Costs	$42,262	$14,551	< 0.0001
Hospital Costs^†	$246,666	$97,010	< 0.0001
Medication Costs^‡	$92,804	$29,076	< 0.0001
Total Cost	$381,732	$140,637	< 0.0001
Cost Per Year	$159,055	$28,127	< 0.0001
Follow-up (years)	2.4 ± 2.5	5.0 ± 3.1	< 0.0001

*Physician costs for care rendered from 1 month prior to surgery until death or end of study taken from Medicare CPT codes for metropolitan Philadelphia in 2004.

^†Hospital costs as estimated from the Temple University Hospital Finance department using data from the Medicare cost report.

^‡Medication costs for days alive and out of the hospital from the time of surgery until the end of study.

Figure 3 Causes of death in transplantation patients included complications from immunosuppression, medications, and acute and chronic graft failure.

Figure 4 Kaplan–Meier analysis showing that survival is greater following LVRS than following transplantation in patients with baseline FEV₁ 20–30% at all times with a p = 0.04 by the log-rank test.

Figure 5 Compares changes in FEV₁, 6-minute walk distance, mBODE and Borg from before surgery to 1-year post-surgery between LVRS (shown on the left) and transplantation patients (shown on the right) with a baseline FEV₁ 20–30%. More transplantation patients are missing or dead at 1-year (below dotted line). While no LVRS patients died within 1 year following surgery, more did not improve following surgery (also below dotted line). Of patients who survived 1 year post-surgery, the transplantation patients had greater improvements in functional status (above dotted line).