Lung Volume Reduction Surgery: Re- interpreted With Longitudinal Data Analyses Methodology

Abstract Background The largest randomised controlled trial evaluating results of lung volume reduction surgery (LVRS) was conducted by the National Emphysema Treatment Trial (NETT) that published a series of reports for outcomes up to 24 months. However, patient outcomes were difficult to interpret due to limitations in and the presentation of conventional statistical analyses applied to longitudinal data. We re-evaluated the NETT results using longitudinal data methodology to report longer term outcomes to facilitate interpretation by clinicians and patients who are considering LVRS for emphysema management. Methods Trial data was released by the United States National Institute of Health and the United States National Heart, Lung and Blood Institute, and analysed using a mixed effects model. Data on the difference in lung function parameters between patients receiving surgery versus medical care out to 5 years was estimated and presented. Results The five-year differences in patients randomised to LVRS was a small but sustained improvement in lung function parameters of FEV1, FVC and RV of +1.4% (P Conclusions Our results suggest that LVRS continues to have an important role in severe emphysema patients’ management with long term benefits to lung function parameters and a sustained improvement to the relief of dyspnoea.