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Analytic Morphomics Are Related to Outcomes After Lung Volume Reduction Surgery

      :Lung volume reduction surgery continues to have a high morbidity despite National Emphysema Treatment Trial selection criteria. This study evaluated the association between analytic morphomics on chest computed tomography scans and outcomes after lung volume reduction surgery. In a retrospective review of 85 lung volume reduction surgery patients from 1998-2013, dorsal muscle group area, subcutaneous and visceral fat area, and bone mineral density were assessed using analytic morphomics. Lung density was divided into five levels of increasing density (Lung density 1, emphysema; 2, normal lung; 4-5, scarring). Outcomes including survival, hospital length of stay, readmission at 30 days, and pulmonary complications were analyzed using univariate and multivariable techniques. Pulmonary complications developed in 27.1% (23/85). Mortality at 90 days was 9.4% (8/85). On multivariable analysis, lower bone mineral density (Odds ratio 0.61; 95% confidence interval 0.39-0.95) was associated with decreased survival, longer length of stay (0.83; 0.77-0.89), and readmissions (0.39; 0.15-1.00). Higher lung density 5:lung density 2 volume (1.84; 1.05-3.23), possibly due to scarring, was associated with pulmonary complications and longer length of stay (1.32; 1.23-1.41) while lower subcutaneous fat area:height was associated with readmissions which may reflect decreased metabolic reserve (0.35; 0.13-0.93). Patients with signs of frailty including lower bone mineral density may be at increased risk of adverse outcomes including decreased survival after lung volume reduction surgery. The results of this hypothesis-generating study will need to be confirmed in larger, multicenter trials to determine whether analytic morphomics can improve risk stratification and patient selection.

      Keywords

      Abbreviations:

      BMD (Bone mineral density), BMI (body mass index), COPD (chronic obstructive pulmonary disease), CT (computed tomography), DLCO (diffusion capacity of lung for carbon monoxide), DICOM (Digital Imaging and Communications in Medicine), DMG (dorsal muscle group), FEV1 (forced expiratory volume in one second), Ht (height), HU (Hounsfield Unit), ICU (intensive care unit), IRR (incidence rate ratio), LOS (length of stay), LD (lung density), LVRS (lung volume reduction surgery), NETT (National Emphysema Treatment Trial), NHANES III (National Health and Nutrition Examination Survey), ND (normal density), STS (Society of Thoracic Surgeons)
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      Linked Article

      • Commentary: Analytic Morphomics and LVRS – A Story of Frailty and Fibrosis
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          Lung volume reduction surgery (LVRS) is a known therapeutic approach for the management of emphysematous disease. Much information about selection criteria and outcomes after LVRS derives from the National Emphysema Treatment Trial (NETT).1 Although LVRS is an accepted operation for severe emphysema, this operation is arguably underutilized, which may be secondary to limited access to specialized centers, lack of awareness of NETT results or misinterpretation of LVRS benefits, perceptions of LVRS assessment being too complex and related to higher costs, and limited availability of pulmonary rehabilitation programs.
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