Comparison of open and thoracoscopic bilateral volume reduction surgery: Complications analysis

Background. The effectiveness of lung volume reduction for the treatment of patients with emphysema is well established but data about the surgical ap proach, the postoperative management, and complications are limited. We rep ort a comparison of patients undergoing bilateral lung volume reduction (BL VRS) via median sternotomy and thoracoscopic techniques with emphasis on ho spital course and complications. Methods. All patients undergoing BLVRS at Hospital of University of Pennsyl vania were analyzed for mortality and morbidity, using a combination of pro spective data analysis and retrospective chart review. Results. Patients undergoing BLVRS via median sternotomy were older than th ose undergoing video-assisted thoracoscopic surgery (VATS) procedures (63.9 +/- 6.89 vs 59.3 +/- 9.4 years, p = 0.005). Operating time was longer for the VATS procedure (147 versus 129 minutes, p = 0.006) while estimated bloo d less was greater for median sternotomy (209 versus 82 L, p = 0.0000017). Significant differences were found in intensive care unit stay, days intuba ted, life-threatening complications, respiratory complications, requirement for tracheostomy, and death that favored VATS BLVRS. When only later cohor ts of patients were compared, more life-threatening complications and death s were found in patients undergoing BLVRS by median sternotomy. There were no differences between early and late median sternotomy BLVRS patients. Twe nty-six percent of the lethal complications in median sternotomy BLVRS pati ents were bowel perforations, equally divided between duodenal ulcers and c olons. Conclusions. Managing patients after BLVRS remains complex. Bilateral video -assisted volume reduction offers equivalent functional outcome with potent ially decreased morbidity and mortality. Gastrointestinal perforations can complicate the management of these patients. (C) 1998 by The Society of Tho racic Surgeons.