Journal article
Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial
The Journal of thoracic and cardiovascular surgery, Vol.131(1), pp.43-53
2006
DOI: 10.1016/j.jtcvs.2005.09.006
PMID: 16399293
Abstract
We sought to identify predictors of operative mortality, pulmonary morbidity, and cardiovascular morbidity after lung volume reduction surgery.
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).
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:
Relative odds
P value
Operative mortality
Non–upper-lobe predominance (radiologist)
2.99
.009
Pulmonary morbidity
Age in years
1.05
.02
FEV
1 % predicted
0.97
.05
D
lco % predicted
0.97
.01
Cardiovascular morbidity
Age in years
1.07
.004
Oral steroid use
1.72
.04
Non–upper-lobe predominance (QIA α measure)
2.67
<.001
FEV
1
, Forced expiratory volume in 1 second;
D
lco
, diffusion capacity;
QIA, quantitative image analysis.
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.
Details
- Title: Subtitle
- Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial
- Creators
- Keith S Naunheim - Division of Cardiothoracic Surgery, St Louis University Health Sciences Center, St Louis, MoDouglas E Wood - University of Washington, and the Cost-Effectiveness Data Center, Fred Hutchinson Cancer Research Center, Seattle, WashMark J Krasna - University of Maryland at Baltimore and Johns Hopkins Hospital, Baltimore, MdMalcolm M DeCamp - Cleveland Clinic Foundation, Cleveland, OhioMark E Ginsburg - Columbia University, New York, and Long Island Jewish Medical Center, New Hyde Park, NYRobert J McKenna - Cedars-Sinai Medical Center, Los Angeles, CalifGerard J Criner - Temple University Medical Center, Philadelphia, PaEric A Hoffman - CT Scan Image Storage and Analysis Center, University of Iowa, Iowa City, IowaAlice L Sternberg - Coordinating Center, Johns Hopkins University, Baltimore, MdClaude Deschamps - Mayo Foundation, Rochester, Minn
- Resource Type
- Journal article
- Publication Details
- The Journal of thoracic and cardiovascular surgery, Vol.131(1), pp.43-53
- Publisher
- Mosby, Inc
- DOI
- 10.1016/j.jtcvs.2005.09.006
- PMID
- 16399293
- ISSN
- 0022-5223
- eISSN
- 1097-685X
- Language
- English
- Date published
- 2006
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
- Record Identifier
- 9984051706702771
Metrics
11 Record Views