|
|
| Short Contents | Full Contents | Other books NCBI |
|
|
Surgeon General Reports, SAMHSA TIPs, SAMHSA PEPs  AHCPR Archived Technology AssessmentsLung-Volume Reduction Surgery for End-Stage Chronic Obstructive Pulmonary Disease Prepared by: Thomas V. Holohan, M.D., FACP, and Harry Handelsman, D.O. Health Technology Assessment: Number 10 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Rockville, Maryland September 1996 AHCPR Pub. No. 96-0062 View the Medline Citation and Related Citations using PubMed AbstractLung-volume reduction surgery (LVRS) has been proposed as a palliative treatment for selected patients with diffuse emphysema and end-stage chronic obstructive pulmonary disease who have failed conventional therapy. A number of surgical techniques have been used that are designed to reduce lung volume by surgical resection or laser plication. These techniques are designed to restore previous compromised lung elastic recoil so that expiratory airflow obstruction is reduced, respiratory mechanics are improved, and disabling dyspnea is relieved. Preliminary data derived from both published and unpublished information indicate some favorable short-term benefits. However, objective postoperative data are available for only a small proportion of patients, and long-term followup data are not available. In addition, these surgeries are associated with significant morbidity (and a 6 percent [approximate] surgical mortality) and prolonged hospital stays in a substantial percentage of patients. Patient selection criteria are heterogeneous and in flux, and controversy continues concerning the most appropriate surgical techniques for various categories of patients.
The current data do not permit a logical and scientifically defensible conclusion regarding the risks and benefits of LVRS. The Center for Health Care Technology (CHCT) evaluates the risks, benefits, and clinical effectiveness of new or unestablished medical technologies. In most instances, assessments address technologies that are being reviewed for purposes of coverage by federally funded health programs. CHCT's assessment process includes a comprehensive review of the medical literature and emphasizes broad and open participation from within and outside the Federal Government. A range of expert advice is obtained by widely publicizing the plans for conducting the assessment through publication of an announcement in the Federal Register and solicitation of input from Federal agencies, medical specialty societies, insurers, and manufacturers. The involvement of these experts helps ensure inclusion of the experienced and varying viewpoints needed to round out the data derived from individual scientific studies in the medical literature. CHCT analyzed and synthesized data and information received from experts and the scientific literature. The results are reported in this assessment. Each assessment represents a detailed analysis of the risks, clinical effectiveness, and uses of new or unestablished medical technologies. If an assessment has been prepared to form the basis for a coverage decision by a federally financed health care program, it serves as the Public Health Service's recommendation to that program and is disseminated widely. CHCT is one component of the Agency for Health Care Policy and Research (AHCPR),
Public Health Service, Department of Health and Human Services.
|
