Journal article
Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery
The Journal of thoracic and cardiovascular surgery, Vol.127(5), pp.1350-1360
05/2004
DOI: 10.1016/j.jtcvs.2003.11.025
PMID: 15115992
Abstract
The National Emphysema Treatment Trial, a randomized trial comparing lung volume reduction surgery with medical therapy for severe emphysema, included randomized and nonrandomized comparisons of the median sternotomy and video-assisted thoracoscopic approaches for lung volume reduction surgery.
Lung volume reduction surgery was performed by median sternotomy only at 8 centers and video-assisted thoracoscopy only at 3 centers; 6 centers randomized the approach to lung volume reduction surgery. Mortality, morbidity, functional status, and costs were assessed.
In the nonrandomized comparison, 359 patients received lung volume reduction surgery by median sternotomy, and 152 patients received lung volume reduction surgery by video-assisted thoracoscopy. The 90-day mortality was 5.9% for median sternotomy and 4.6% for video-assisted thoracoscopy (P =.67). Overall mortality was 0.08 deaths per person-year for median sternotomy and 0.10 deaths per person-year for video-assisted thoracoscopy (video-assisted thoracoscopy-median sternotomy risk ratio, 1.18; P =.42). Complication rates were low and not statistically different for the 2 approaches. The median hospital length of stay was longer for median sternotomy than for video-assisted thoracoscopy (10 vs 9 days; P =.01). By 30 days after surgery, 70.5% of median sternotomy patients and 80.9% of video-assisted thoracoscopy patients were living independently (P =.02). Functional outcomes were similar for median sternotomy and video-assisted thoracoscopy at 12 and 24 months. Costs for the operation and the associated hospital stay and costs in the 6 months after surgery were both less for video-assisted thoracoscopy than for median sternotomy (P <.01 in both cases). Similar results were noted for the randomized comparison.
Morbidity and mortality were comparable after lung volume reduction surgery by video-assisted thoracoscopy or median sternotomy, as were functional results. The video-assisted thoracoscopic approach to lung volume reduction surgery allowed earlier recovery at a lower cost than median sternotomy.
Details
- Title: Subtitle
- Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery
- Creators
- Robert J McKenna Jr - NETT Coordinating Center, 615 N Wolfe St, Room 5010, Baltimore, MD 21205, USAJoshua O BendittMalcolm DeCampClaude DeschampsLarry KaiserShing M LeeZab MohsenifarSteven PiantadosiScott RamseyJohn ReillyJames UtzNational Emphysema Treatment Trial Research Group
- Contributors
- Brian F Mullan (Contributor) - University of Iowa, Internal Medicine
- Resource Type
- Journal article
- Publication Details
- The Journal of thoracic and cardiovascular surgery, Vol.127(5), pp.1350-1360
- DOI
- 10.1016/j.jtcvs.2003.11.025
- PMID
- 15115992
- ISSN
- 0022-5223
- eISSN
- 1097-685X
- Grant note
- N01HR76103 / NHLBI NIH HHS N01HR76119 / NHLBI NIH HHS N01HR76107 / NHLBI NIH HHS N01HR76115 / NHLBI NIH HHS N01HR76111 / NHLBI NIH HHS N01HR76114 / NHLBI NIH HHS N01HR76102 / NHLBI NIH HHS N01HR76104 / NHLBI NIH HHS N01HR76116 / NHLBI NIH HHS N01HR76110 / NHLBI NIH HHS N01HR76108 / NHLBI NIH HHS N01HR76105 / NHLBI NIH HHS N01HR76109 / NHLBI NIH HHS N01HR76113 / NHLBI NIH HHS N01HR76101 / NHLBI NIH HHS N01HR76106 / NHLBI NIH HHS N01HR76118 / NHLBI NIH HHS N01HR76112 / NHLBI NIH HHS
- Language
- English
- Date published
- 05/2004
- Academic Unit
- Radiology; Internal Medicine
- Record Identifier
- 9984094315302771
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