The Impact of a Newly Established Multidisciplinary Team on the Interventional Treatment of Patients With Emphysema

Abstract

Background: The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting. Objectives: To investigate the impact of a newly established dedicated emphysema MDT meeting on the interventional treatment of such patients. Methods: During a study period of 4 years, the outcome of 44 patients who underwent intervention according to the proposal of the emphysema MDT (group A) was compared with the outcome of 44 propensity score matched patients (group B) treated without the emphysema MDT proposal. Results: More LVRS and less EBV insertions were performed in group A ( P = .009). In group B, the interventions were performed sooner than in group A ( P = .003). Postoperative overall morbidity and length of in-hospital stay were similar in the 2 groups ( P = .918 and .758, respectively). Improvement of breathing ability was reported in more patients from group A ( P = .012). In group B, the total number of re-interventions was higher ( P = .001) and the time to re-intervention had the tendency to be less ( P = .069). Survival was similar between the 2 groups ( P = .884). Intervention without discussion at the MDT and EBV as initial intervention was an independent predictor of re-intervention. Conclusions: Interventional treatment for patients with chronic obstructive pulmonary disease (COPD) after discussion at a dedicated MDT involved more LVRS performed, required fewer interventions for their disease, and had longer re-intervention-free intervals and better breathing improvement.

Impact of the type of initial intervention on the outcomes of lung volume reduction for emphysema: a propensity matched study

“…In 6 cases (13.6%) the valves were coughed out by the patient (and were repositioned) and in 2 (4.5%) the valves had to be removed because of bleeding post insertion (these patients finally underwent LVRS). The median number of valves inserted was 3 [2][3][4][5][6]. In 4 cases a chest drain was necessitated to be inserted for pneumothorax (mentioned also below).…”

“…All decisions were based on NICE guidelines and on the findings of the National Emphysema Trial (NET) trial (Table 1) (3,(6)(7)(8) Patients who fulfilled the criteria for LVR intervention and had developed fissures [proved on thin slice computed tomography (CT) scan and the Strat-X analysis] could also be eligible for EBVs apart from LVRS (6).…”

“…These interventional modalities are offered to patients after discussion at a dedicated emphysema multidisciplinary team (MDT), as recommended by the National Institute of Clinical Excellence (NICE) guidelines (5,6).…”

Thoracic Society of Australia and New Zealand Position Statement: Respiratory nursing

“…Multidisciplinary care has been shown to reduce the incidence of respiratory disease through screening, optimal clinical management and health education, as well as contributing to a reduction in disease morbidity and an improvement in quality of life. [28][29][30] Respiratory nursing, in its entirety, needs to be recognized as a specialist area of practice and workforce. This recognition is due to the contribution respiratory nurses, using their knowledge and skills, make every day in every setting for the improvement of adult and paediatric lung health.…”

“…The TSANZ position is that respiratory nurses are professional members of multidisciplinary team and in tandem with medical, scientific and allied health colleagues significantly contribute to the highest level of respiratory care today. Multidisciplinary care has been shown to reduce the incidence of respiratory disease through screening, optimal clinical management and health education, as well as contributing to a reduction in disease morbidity and an improvement in quality of life 28–30 …”