A study reported morbidity and mortality differences between lung volume reduction surgery and endobronchial valve placement for advanced emphysema, with risk-adjusted analysis revealing higher complication rates in those who received endobronchial valve placement.

In the study, presented at the 2025 Society of Thoracic Surgeons (STS) Annual Meeting, investigators analyzed outcomes data comparing lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement in patients with advanced emphysema.

The Medicare claims database study involved 3,219 Medicare beneficiaries (LVRS: n = 2,378; EBV: n = 841) and documented that despite recipients of EBV placement having lower initial Elixhauser Comorbidity Index scores and shorter hospital stays, they experienced higher mortality rates and more procedure-related complications following risk adjustment.

"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," emphasized lead investigator J. W. Awori Hayanga, MD, MPH, Professor of Thoracic Surgery at West Virginia University Medicine.

Historical LVRS data showed an 8% mortality rate. In the current analysis, 79.8% (n = 1,897/2,378) of LVRS procedures used minimally invasive, video-assisted thoracoscopic or robotic approaches, whereas 20.2% (n = 481/2,378) were open surgeries.

The investigators employed doubly-robust risk-adjusted models to compare outcomes between January 1, 2019, and December 31, 2022. The analysis revealed that patients who received EBV placement required more subsequent interventions despite having shorter initial hospitalizations and lower hospital charges.

"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," Dr. Hayanga noted.

EBV placement received U.S. Food and Drug Administration approval in 2018 for the treatment of chronic obstructive pulmonary disease. The investigators recommend reviewing multidisciplinary decision-making protocols regarding surgical vs bronchoscopic interventional therapy for advanced emphysema management based on these contemporary LVRS and EBV placement outcome data.