Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery

Robert J. McKenna, Joshua O. Benditt, Malcolm DeCamp, Claude Deschamps, Larry Kaiser, Shing M. Lee, Zab Mohsenifar, Steven Piantadosi, Scott Ramsey, John Reilly, James Utz

    Research output: Contribution to journalArticle

    Abstract

    Background: 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. Methods: 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. Results: 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. Conclusions: 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.

    Original languageEnglish (US)
    Pages (from-to)1350-1360
    Number of pages11
    JournalJournal of Thoracic and Cardiovascular Surgery
    Volume127
    Issue number5
    DOIs
    StatePublished - May 2004

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    Video-Assisted Thoracic Surgery
    Sternotomy
    Pneumonectomy
    Thoracoscopy
    Safety
    Video-Assisted Surgery
    Length of Stay
    Mortality
    Emphysema
    Costs and Cost Analysis
    Morbidity
    Hospital Costs
    Ambulatory Surgical Procedures

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery. / McKenna, Robert J.; Benditt, Joshua O.; DeCamp, Malcolm; Deschamps, Claude; Kaiser, Larry; Lee, Shing M.; Mohsenifar, Zab; Piantadosi, Steven; Ramsey, Scott; Reilly, John; Utz, James.

    In: Journal of Thoracic and Cardiovascular Surgery, Vol. 127, No. 5, 05.2004, p. 1350-1360.

    Research output: Contribution to journalArticle

    McKenna, RJ, Benditt, JO, DeCamp, M, Deschamps, C, Kaiser, L, Lee, SM, Mohsenifar, Z, Piantadosi, S, Ramsey, S, Reilly, J & Utz, J 2004, 'Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery', Journal of Thoracic and Cardiovascular Surgery, vol. 127, no. 5, pp. 1350-1360. https://doi.org/10.1016/j.jtcvs.2003.11.025
    McKenna, Robert J. ; Benditt, Joshua O. ; DeCamp, Malcolm ; Deschamps, Claude ; Kaiser, Larry ; Lee, Shing M. ; Mohsenifar, Zab ; Piantadosi, Steven ; Ramsey, Scott ; Reilly, John ; Utz, James. / Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2004 ; Vol. 127, No. 5. pp. 1350-1360.
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    abstract = "Background: 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. Methods: 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. Results: 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. Conclusions: 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.",
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    T1 - Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery

    AU - McKenna, Robert J.

    AU - Benditt, Joshua O.

    AU - DeCamp, Malcolm

    AU - Deschamps, Claude

    AU - Kaiser, Larry

    AU - Lee, Shing M.

    AU - Mohsenifar, Zab

    AU - Piantadosi, Steven

    AU - Ramsey, Scott

    AU - Reilly, John

    AU - Utz, James

    PY - 2004/5

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    N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

    AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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