Contemporary Practice Patterns of Lung Volume Reduction Surgery in the United States. Journal Article

Authors: Abdelsattar, ZM; Allen, M; Blackmon, S; Cassivi, S; Mandrekar, J; Nichols, F; Reisenauer, J; Wigle, D; Shen, KR
Article Title: Contemporary Practice Patterns of Lung Volume Reduction Surgery in the United States.
Abstract: BACKGROUND: Contemporary data on LVRS is sparse, particularly in regards to utilization and surgical outcomes. In this context, we analyze the practice patterns and outcomes of LVRS nationally. METHODS: We identified all patients (n=1617) undergoing LVRS at 165 hospitals between 2001 and 2017 from the STS General Thoracic Database. Practice patterns were assessed at the hospital and STS regional levels. In addition we obtained regional COPD prevalence data from the Centers for Disease Control. We used hierarchical logistic regression to estimate associations with each outcome of interest and calculate risk- and reliability-adjusted outcome rates. RESULTS: Since 2011, national LVRS utilization has been increasing with decreasing mortality rates (3.1% risk adjusted mortality in 2016). There is wide regional variation in LVRS average caseload that is not congruent with national COPD prevalence (Pearson correlation coefficient= -0.11). On multivariable analysis, only older age (aOR=1.05, p0.001), male sex(aOR=1.5, p=0.007), underweight BMI (aOR=1.94, p=0.027) and ECOG score of 4 (aOR=5.17, Z-score 3.91, p=0.001) were associated with the occurrence of the composite outcome of major morbidity or mortality. At the hospital level, 6 hospitals performed 40% of all LVRS nationally with adjusted national 30-day mortality rate of 4.3% and composite outcome rate of 15.8%. Despite this, there was minimal variation in adjusted outcome rates. CONCLUSIONS: National utilization of LVRS is increasing and it has become safer overall, even at lower volume hospitals. There is regional variation in LVRS use that does not mirror national COPD prevalence suggesting access disparities. The findings have potential policy implications.
Journal Title: The Annals of Thoracic Surgery
ISSN: 1552-6259; 0003-4975
Publisher: Unknown  
Date Published: 2020