Lung Volume Reduction Surgery for Emphysema May Have Better Outcomes than Previously Reported

LOS ANGELES—January 26, 2025—As contemporary surgical practice continues to evolve, patients who undergo surgical lung volume reduction (LVRS) for advanced emphysema may survive longer and with fewer complications than they did in the past—and they may even fare better than those who opt for endobronchial valve (EBV) placement.

At the 2025 Society of Thoracic Surgeons (STS) Annual Meeting, researchers presented risk-adjusted findings that shed new light on treatments for severe emphysema. Despite having shorter hospital stays, lower hospital charges, and lower Elixhauser Comorbidity Index scores—a tool that quantifies pre-existing conditions and how they affect treatment outcomes—investigators found that patients who underwent EBV placement ultimately had more complications and higher longitudinal risk of death than those who received LVRS.

“The standard treatment using bronchodilators is typically sufficient for most patients, but often, the disease is very severe and has no definitive therapeutic options,” said lead study author J. W. Awori Hayanga, MD, MPH, professor of thoracic surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University.

“Lung transplantation is not always a durable solution because of the shortage of donors compared to the demand for organs,” Dr. Hayanga explained. “The potential of surgical volume reduction was duly explored in the late 1990s in patients with severe emphysema. The surgical approach, however, did not gain broad popularity because of the high mortality of 8% and the small group of patients believed to benefit from the procedure.”

Early trials in the 2010s tested EBVs as an alternative option, said Dr. Hayanga, and after the valves received FDA approval in 2018, their use and popularity has grown rapidly as a treatment for patients with conditions like chronic obstructive pulmonary disorder (COPD).

Long-term data on how patients with severe emphysema fared after EBV placement, however, remain limited. Dr. Hayanga’s team examined mortality and procedure-related complications in patients with advanced emphysema, using doubly-robust risk-adjusted models that compared patient outcomes after EBV placement versus after LVRS.

“We observed that patients undergoing EBV placement have higher occurrences of various complications over time, often need a greater number of interventions, and even suffer higher mortality compared to those undergoing LVRS in contemporary surgical practice, where techniques have become much less invasive than they were 20 years ago when surgical options were first evaluated,” said Dr. Hayanga.

The team examined data from the Centers for Medicare and Medicaid Services inpatient claims database, evaluating all beneficiaries with severe emphysema undergoing either LVRS or EBV between January 1, 2019, and December 31, 2022. They included a total of 3,219 patients; 2,378 received LVRS and 841 received EBV placement.

Prior to risk adjustment, EBV recipients had lower Elixhauser comorbidity scores, shorter lengths of hospital stay, and lower hospital charges compared to those who underwent LVRS. Most LVRS procedures (1,897) were minimally invasive video-assisted thoracoscopic or robotic surgeries, while 481 were open surgeries.

“Medicare beneficiaries who undergo EBV present with fewer comorbidities, but after risk adjustment they have higher mortality and procedure-related morbidity than those undergoing LVRS,” Dr. Hayanga said.

The team said that these results suggest the need to revisit multidisciplinary decision-making about the role of surgery over bronchoscopic interventional therapy in the management of advanced emphysema.

“Outcomes after surgery were better than previously reported and were often better than those after valve placement,” Dr. Hayanga observed. “It is likely that patients do far better after surgery than they used to.”

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About STS Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,800 cardiothoracic surgeons, researchers, and allied healthcare professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to improve the lives of patients with cardiothoracic diseases.