OUTCOME OF MEDICARE PATIENTS WITH EMPHYSEMA SELECTED FOR, BUT DENIED,A LUNG-VOLUME REDUCTION OPERATION

Background. Lung Volume reduction operation shows promise in relieving symptoms and improving function in highly selected patients with emph ysema. Withdrawal of Medicare funding for patients selected for operat ion by standard criteria created a matched control group with which to compare lung volume reduction recipients. Methods. A retrospective st udy was done comparing 22 volume reduction candidates denied operation with 65 contemporaneous and comparable volume reduction recipients. B aseline physiologic characteristics were compared and longitudinal mea sures of pulmonary function were followed up for 24 months. Results. P atients denied operation were similar to volume reduction recipients i n all baseline measurements. Patients denied operation experienced a p rogressive worsening of their function, whereas volume reduction patie nts experienced sustained improvements. Absolute survival to date is 8 2% for the surgical group and 64% for the medical group. Conclusions. The improvement seen in volume reduction patients cannot be attributed to the effects of patient selection or preoperative and postoperative rehabilitation. (C) 1998 by The Society of Thoracic Surgeons.