Lung volume reduction surgery since the National Emphysema Treatment Trial: Study of Society of Thoracic Surgeons Database

ObjectivesThe National Emphysema Treatment Trial demonstrated that lung volume reduction surgery is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the United States, this study sought to assess practice patterns and outcomes for lung volume reduction surgery on a national level since the National Emphysema Treatment Trial.MethodsAggregate statistics on lung volume reduction surgery reported in the Society of Thoracic Surgeons Database from January 2003 to June 2011 were analyzed to assess procedure volume, preoperative and operative characteristics, and outcomes. Comparisons with published data from the National Emphysema Treatment Trial were made using chi-square and 2-sided t tests.ResultsIn 8.5 years, 538 patients underwent lung volume reduction surgery, with 20 to 118 cases reported in the Society of Thoracic Surgeons Database per year. When compared with subjects in the National Emphysema Treatment Trial, subjects in the Society of Thoracic Surgeons Database were younger (P < .001), a larger proportion underwent the procedure thoracoscopically (P < .001), and forced expiratory volume in 1 second was 31% versus 28% of predicted (P < .001). When mortality was compared between subjects in the Society of Thoracic Surgeons Database and all subjects in the National Emphysema Treatment Trial randomized to surgery, there were no significant differences. However, mortality was 3% higher in subjects in the Society of Thoracic Surgeons Database when compared with the non–high-risk National Emphysema Treatment Trial subset (P = .005).ConclusionsThis study demonstrates the importance of patient selection and the need to develop consensus on appropriate benchmarks for mortality rates after lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the United States in a multidisciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema

The number of inpatient consultations is negatively correlated with patient satisfaction in patients with prolonged hospital stays

Patient satisfaction is often measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Our aim was to examine the structural and clinical determinants of satisfaction among inpatients with prolonged lengths of stays (LOS)

A nonlinear rheological assessment of muscle recovery from eccentric stretch injury

To better understand the mechanical behavior of healing skeletal muscle; specifically the tissue's response after acute eccentric stretch injury. Rabbit tibialis anterior (TA) muscle tendon units were subjected to an in vivo single stretch (eccentric) injury and mechanically evaluated (constant rate elongation to failure) at 1, 3, and 7 d postinjury. In addition to a traditional linear analysis (linear stiffness and failure load), an existing nonlinear rheological model was modified to interpret the experimental load-to-failure data. The models' performance were evaluated and discussed. No significant injury effect was observed, either within or between groups, across the 7-d healing interval, using the linear analysis. However, interpretation of the data using our nonlinear phenomenological model identified significant changes in mechanical behavior that went undetected by linear analyses. Percent differences, between injured and contralateral control limbs, of model parameter estimates were analyzed. Nonparametric statistical analysis illustrated significant changes in the first-order stiffness (k1) throughout the 7-d healing interval. Model simulations using mean values of each parameter revealed increased low-load tissue compliance after injury, with a decrease in linear slope that recovered steadily toward control values by day 7. At 7 d postinjury, virtually no differences were observed between injured and sham control tissues. Our findings suggest that acute eccentric injury increases the muscle's compliance 24 h after injury, with a steady recovery to uninjured values by the 7th day, yet these changes went undetected by linear analysis. Therefore, nonlinear analysis is necessary to recognize valuable information contained in the low-load region and to quantify important biomechanical phenomena of stretch-injured healing skeletal muscle

Therapeutic selective neck dissection outcomes.

OBJECTIVE: To evaluate the effectiveness of selective neck dissection in patients with nodal metastases from head and neck squamous cell carcinoma. STUDY DESIGN: Historical cohort study. SETTING: Academic medical center. SUBJECTS AND METHODS: A chart review was performed on 156 subjects with clinically positive regional nodal metastases managed initially with surgery, including neck dissection. Sixty-nine subjects underwent selective neck dissection (less than 5 levels), and the majority received postoperative radiotherapy (80%). Primary outcomes included Kaplan-Meier three-year ipsilateral regional control and five-year overall survival. Cox proportional univariate and multivariate analyses were performed to determine those factors associated with outcome. RESULTS: There were two ipsilateral regional recurrences among those undergoing selective neck dissection, yielding a regional control rate of 95.9 percent. Among those undergoing comprehensive neck dissection, nine ipsilateral regional recurrences occurred, yielding a control rate of 86.0 percent (P = 0.053). No selective neck dissection recurrences occurred in a preserved level. Selective neck dissection, as compared to comprehensive neck dissection, was not adversely associated with regional recurrence, survival, or distant metastasis, even after adjusting for possible confounders (hazard ratio 0.21, P = 0.055). CONCLUSION: These results demonstrate high rates of regional disease control (96%) following selective neck dissection and radiotherapy in patients with positive neck node metastases. In this population, performing selective neck dissection with adjuvant radiotherapy for the majority of patients is supported as an effective treatment approach