Odds for poor outcomes high with endobronchial valve vs. lung volume reduction surgery
Key takeaways:
- Patients who received an endobronchial valve vs. lung volume reduction surgery had significantly heightened odds for mortality and readmission.
- Risk adjustment is important in future research on this topic.
Medicare beneficiaries with emphysema who received an endobronchial valve vs. lung volume reduction surgery faced elevated risk-adjusted odds for poor outcomes, according to data presented at the Society of Thoracic Surgeons Annual Meeting.
“The important take-home message is that we should evaluate patients in a multistakeholder, multidisciplinary fashion that brings together pulmonologists and thoracic surgeons so that we can offer the best options to the patient that is not agenda driven, but evidence driven,” J. W. Awori Hayanga, MD, MPH, professor of thoracic surgery in the department of cardiovascular and thoracic surgery at West Virginia University, told Healio.
In this study of data from January 2019 to December 2022, Hayanga and colleagues analyzed Medicare beneficiaries with severe emphysema who either had lung volume reduction surgery (n = 2,378) or endobronchial valve placement (n = 841) to determine how the odds for various outcomes differ between the two therapeutic options.
Among those who received lung volume reduction surgery, a greater number of patients had video-assisted thoracoscopic/robotic surgery rather than open surgery (1,897 vs. 481).
Researchers found that three factors significantly differed in an analysis unadjusted for risk between patients in the endobronchial valve group and patients in the lung volume reduction surgery group: Elixhauser comorbidity score (3.37 vs. 3.86; P < .001), length of stay (4 days vs. 7 days; P < .0001) and hospital charge ($124,540 vs. $146,221; P < .0001).
Of the two groups, patients in the endobronchial valve group had elevated odds for several negative outcomes in a doubly robust risk-adjusted model inclusive of frailty, according to researchers.
“We found that after risk adjustment, both the short-term and long-term outcomes favored surgery, which was surprising,” Hayanga told Healio.
In terms of mortality, patients who underwent endobronchial valve placement vs. lung volume reduction surgery had significantly heightened odds for 30-day mortality (adjusted OR = 2.68; 95% CI, 1.88-3.87), as well as 1-year all-cause mortality (aOR = 1.75; 95% CI, 1.49-2.07).
The likelihood for two separate readmission outcomes was also significantly increased among those in the endobronchial valve group vs. the lung volume reduction surgery group: 30-day readmission (aOR = 1.4; 95% CI, 1.21-1.63) and 30-day readmission with pneumothorax (aOR = 2.09; 95% CI, 1.58-2.79).
Researchers further reported significantly heightened odds for reintervention with endobronchial valve placement when placed against lung volume reduction surgery (aOR = 17.2; 95% CI, 8.42-42.2). The odds for having a supplementary oxygen requirement followed a similar pattern, as this outcome was more likely in the endobronchial valve group (aOR = 3.49; 95% CI, 2.71-4.55).
“Another surprise was that when you look at the body of literature that has supported the development and use of endobronchial valves, it is based on very modest and subjective improvements in lung function that are often less than the threshold that would be considered significant from a clinical perspective,” Hayanga told Healio.
“Endobronchial valve literature [also] didn’t really look at long-term survival, which is important to patients,” he added.
In addition to evaluating long-term mortality, Hayanga emphasized the importance of risk adjustment in future research on this topic.
“Future studies would have risk adjustment so that we can compare apples with apples,” Hayanga told Healio. “We would select metrics that are themselves durable and beyond the threshold of chance so that we look at metrics that are not just statistically significant, but that are clinically significant.”
Hayanga also stressed the significance of knowing a patient’s comorbidities when deciding between the two therapeutic options.
“We want to make sure that there’s a risk adjustment because having a patient with bad lungs and deciding whether or not they should get valves or surgery may be influenced by their history,” Hayanga told Healio.
“Without looking at other comorbidities, we can ignore very important magnitudes of confounding,” he added.
Reference:
- Lung volume reduction surgery for emphysema may have better outcomes than previously reported. https://www.sts.org/press-releases/lung-volume-reduction-surgery-emphysema-may-have-better-outcomes-previously-reported. Published Jan. 26, 2025. Accessed Jan. 26, 2025.