Surgery for emphysema

Emphysema is a chronic debilitating disease with limited therapeutic options. The rejuvenation and promulgation of lung volume reduction surgery (LVRS) in the mid-1990s provided a potential surgical treatment and new promise for selected emphysema patients. Early widespread application of LVRS and the glowing publications reporting overwhelmingly positive results brought this issue to the attention of the entire thoracic surgery community. Debates occurred at both medical and surgical meetings regarding patient selection, surgical techniques, and the true value of the procedure. However, it was in the regulatory, judicial, and legislative arenas where the most strident controversy occurred. A Medicare review of claims revealed significantly higher morbidity and mortality following LVRS than had been publicly acknowledged or reported. In addition, the lack of a randomized clinical trial demonstrating the benefit of the procedure led to the refusal by Medicare to reimburse for LVRS. It was one of the few times in memory that thoracic surgeons were administratively prohibited from providing a treatment to their patients that most considered to be of significant clinical benefit. As such, it helped bring to realization that in the future, the introduction of innovative new tools and procedures will require surgeons to be engaged not only in the operating room but in the regulatory arena as well. In the future, the thoracic surgery community may well look back on the introduction ...
Source: Chest Surgery Clinics of North America - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Preface Source Type: research