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Underestimation of Mortality Following Lung Volume Reduction Surgery Resulting From Incomplete Follow-up^*

^* From the Departments of Medicine and Surgery (Mr. Butler, Ms. Snyder, and Drs. Wood, Curtis, and Benditt), University of Washington, Seattle, WA; and Medical Service (Dr. Albert), Denver Health Medical Center, and Department of Medicine, University of Colorado Health Sciences Center, Denver, CO.

Correspondence to: Joshua O. Benditt, MD, FCCP, Respiratory Care Services, University of Washington Medical Center, Pulmonary and Critical Care Medicine, Box 356522, Seattle, WA 98195-6522

Study objectives: Incomplete follow-up can bias interpretation of data that are collected in longitudinal studies. We noted that many patients failed to return for follow-up in a study of effect of lung volume reduction surgery (LVRS) on quality of life (QOL). Accordingly, we designed this investigation to determine the reasons patients dropped out, and to assess differences between those who continued in the study (attendees) and those who did not (nonattendees).

Design: Telephone survey.

Subjects: Patients with advanced emphysema who had undergone LVRS and had previously agreed to participate in a longitudinal QOL study.

Results: No differences were found with regard to age, gender, preoperative pulmonary function, or oxygen use between attendees and nonattendees. Long-term mortality in nonattendees (27%) was considerably greater than that seen in attendees (3%, p < 0.05). Distance from the hospital, financial burden, and living out of the region were the most common reasons cited by surviving nonattendees for their failure to return for follow-up.

Conclusions: Studies reporting the long-term mortality after LVRS can be biased in the direction of underestimating the true value if they are compromised by incomplete follow-up.

Key Words: lung volume reduction surgery • mortality study design • survival

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