Year: 2014
Type: conference-abstract
Abstract: Objectives: The physiological and health-status benefits of lung volume reduction surgery (LVRS) are well established, but the uptake has been lower than expected due to concerns over operative mortality. We aimed to construct a model to better quantify these risks and thus instruct decision-making. Methods: Variables associated with 30-day, 90-day and 1 year mortality were assessed in 237 patients undergoing unilateral video-assisted thoracoscopic (VAT) LVRS over a 17-year period. Logistic regression was used to construct a scoring system to predict perioperative (90-day) mortality, and reliability assessed by receiver operating characteristics (ROC) analysis. Results: Thirty-day mortality was 4.2% (10/237); 8.9% (21/237) at 90 days and 11.8% (28/237) at 1 year. The causes of death included: respiratory failure, myocardial infarction. Reduced survival at 90 days was associated with body mass index (BMI) <18.5 kg/m2 (OR 3.14, 95% CI 1.04-9.47, P = 0.042), absolute FEV1 <0.71l (OR 5.47, 95% CI 1.47-20.35, P = 0.011), and DLCO <20% (OR, 5.56, 95% CI 1.17-26.34, P = 0.03). The mortality risk model derived from these variables showed good discriminaion between low/moderate/high risk groups (P < 0.001) at all time points with a high degree of reliability (c = 0.797). There was no early mortality in the 94 patients in the low risk group, and only 1 death in the first year. In the high risk group 30-day mortality was 5/35 patients (14%), rising to 13/35(37%) at 1 year. Conclusions: There is significant variability in perioperative mortality after VAT LVRS. Individualised mortality risk can be predicted using the simple score derived from perioperative characteristics. Increased utilisation of LVRS may be encouraged by more accurate patient information. Disclosure: No significant relationships.
Authors: P. Vaughan, N. Greening, I. Oey, S. Rathinam, D. Waller
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1975243234