Long-Term Follow-Up of Patients Receiving Lung-Volume-Reduction Surgery Versus Medical Therapy for Severe Emphysema by the National Emphysema Treatment.

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Presentation transcript:

Long-Term Follow-Up of Patients Receiving Lung-Volume-Reduction Surgery Versus Medical Therapy for Severe Emphysema by the National Emphysema Treatment Trial Research Group Keith S. Naunheim, MD, Douglas E. Wood, MD, Zab Mohsenifar, MD, Alice L. Sternberg, ScM, Gerard J. Criner, MD, Malcolm M. DeCamp, MD, Claude C. Deschamps, MD, Fernando J. Martinez, MD, Frank C. Sciurba, MD, James Tonascia, PhD, Alfred P. Fishman, MD The Annals of Thoracic Surgery Volume 82, Issue 2, Pages 431-443.e19 (August 2006) DOI: 10.1016/j.athoracsur.2006.05.069 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Kaplan-Meier estimates of the cumulative probability of death as a function of years after randomization to lung volume reduction surgery (LVRS, gray line) or medical treatment (black line) for (a) all patients and (b–d) non-high-risk and upper-lobe-predominant subgroups of patients. The p value is from the Fisher exact test for difference in the proportions of patients who died during the 4.3 years (median) of follow-up. Shown below each graph are the numbers of patients at risk, the Kaplan-Meier probabilities, the ratio of the probabilities (LVRS:Medical), and p value for the difference in these probabilities. This is an intention-to-treat analysis. (a) All patients (N = 1218). (b) Non-high-risk patients (n = 1078). (c) Upper-lobe-predominant and low baseline exercise capacity (n = 290). (d) Upper-lobe-predominant and high exercise capacity (n = 419). (RR = relative risk.) The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Improvement in exercise capacity (increase in maximum work of >10 watts above the patient’s postrehabilitation baseline) at 1, 2, and 3 years after randomization to lung volume reduction surgery (LVRS, open box) or medical treatment (filled box) for (a) all patients and (b–d) non-high-risk and upper-lobe-predominant subgroups of patients. Shown below each graph are the numbers of patients evaluated, the odds ratio for improvement (LVRS:Medical), and the Fisher exact p value for difference in proportion improved. Patients who died or who did not complete the assessment were considered not improved. This is an intention-to-treat analysis. (a) All patients (N = 1218). (b) Non-high-risk patients (n = 1078). (c) Upper-lobe-predominant and low baseline exercise capacity (n = 290). (d) Upper-lobe-predominant and high exercise capacity (n = 419). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Improvement in health-related quality of life (decrease in St. George’s Respiratory Questionnaire total score of >8 units below the patient’s postrehabilitation baseline) at 1, 2, 3, 4, and 5 years after randomization to lung volume reduction surgery (LVRS, open box) or medical treatment (filled box) for (a) all patients and (b–d) non-high-risk and upper-lobe-predominant subgroups of patients. Shown below each graph are the numbers of patients evaluated, the odds ratio for improvement (LVRS:Medical), and the Fisher exact p value for difference in proportion improved. Patients who died or who did not complete the assessment were considered not improved. This is an intention-to-treat analysis. (a) All patients (N = 1218). (b) Non-high-risk patients (n = 1078). (c) Upper-lobe-predominant and low baseline exercise capacity (n = 290). (d) Upper-lobe-predominant and high exercise capacity (n = 419). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Mean change from postrehabilitation baseline in exercise capacity (maximum work) among patients who completed the procedure 6 months and 1, 2, and 3 years after randomization to lung-volume-reduction surgery (LVRS, open circles) or medical treatment (filled circles) for (a) all patients and (b–d) non-high-risk and upper-lobe-predominant subgroups of patients. Error bars represent the standard deviation of the distribution of changes. Shown below each graph are the numbers of patients evaluated and the mean change. This is not an intention-to-treat analysis because it was limited to surviving patients. (a) All patients (N = 1218). (b) Non-high-risk patients (n = 1078). (c) Upper-lobe-predominant and low baseline exercise capacity (n = 290). (d) Upper-lobe-predominant and high exercise capacity (n = 419). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Mean change from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) among patients who completed the procedure 6 months and 1, 2, 3, 4, and 5 years after randomization to lung-volume-reduction surgery (LVRS, open circles) or medical treatment (filled circles) for (a) all patients and (b–d) non-high-risk and upper-lobe-predominant subgroups of patients. Error bars represent the standard deviation of the distribution of changes. Shown below each graph are the numbers of patients evaluated and the mean change. This is not an intention-to-treat analysis because it was limited to surviving patients. (a) All patients (N = 1218). (b) Non-high-risk patients (n = 1078). (c) Upper-lobe-predominant and low baseline exercise capacity (n = 290). (d) Upper-lobe-predominant and high exercise capacity (n = 419). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A1 Kaplan-Meier estimates of the cumulative probability of death as a function of years after randomization to lung volume reduction surgery (LVRS, gray line) or medical treatment (black line) for (a) high-risk and (b–c) the lower-lobe-predominant subgroups of patients. The p value is from the Fisher exact test for difference in the proportions dying during 4.3 years (median) of follow-up. Shown below each graph are the numbers of patients at risk, the Kaplan-Meier probabilities, the ratio of the probabilities (LVRS:Medical), and the p value for the difference in these probabilities. This is an intention-to-treat analysis. (a) High-risk patients (n = 140). (b) Non-upper-lobe-predominant and low baseline exercise capacity (n = 149). (c) Non-upper-lobe-predominant and high baseline exercise capacity (n = 220). (RR = relative risk.) The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A2 Improvement in exercise capacity (increase in maximum work of >10 watts above the patient’s postrehabilitation baseline level) at 1, 2, and 3 years after randomization to lung volume reduction surgery (LVRS, open boxes) or medical treatment (filled boxes) for (a) high-risk patients and (b–c) the lower-lobe-predominant subgroups of patients. Shown below each graph are the numbers of patients evaluated, the odds ratio for improvement (LVRS:Medical), and the Fisher exact p value for the difference in proportion improved. Patients who died or who did not complete the assessment were considered not improved. This is an intention-to-treat analysis. (a) High-risk patients (n = 140). (b) Non-upper-lobe-predominant and low baseline exercise capacity (n = 149). (c) Non-upper-lobe-predominant and high baseline exercise capacity (n = 220). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A3 Improvement in health-related quality of life (decrease in St George’s Respiratory Questionnaire total score of >8 units below the patient’s postrehabilitation baseline) at 1, 2, 3, 4, and 5 years after randomization to lung volume reduction surgery (LVRS; open boxes) or medical treatment (filled boxes) for (a) high-risk patients and (b–c) the lower-lobe-predominant subgroups of patients. Shown below each graph are the numbers of patients evaluated, the odds ratio for improvement (LVRS:Medical), and the Fisher exact p value for difference in proportion improved. Patients who died or who did not complete the assessment were considered not improved. This is an intention-to-treat analysis. (a) High-risk patients (n = 140) (b) Non-upper-lobe-predominant and low baseline exercise capacity (n = 149). (c) Non-upper-lobe-predominant and high baseline exercise capacity (n = 220). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A4 Mean change from post rehabilitation baseline in exercise capacity (maximum work) among patients who completed the procedure 6 months and 1, 2, and 3 years after randomization to lung-volume-reduction surgery (LVRS, open circles) or medical treatment (filled circles) for (a) high-risk patients and (b–c) the lower-lobe-predominant subgroups of patients. Error bars represent the standard deviation of the distribution of changes. Shown below each graph are the numbers of patients evaluated and the mean change. This is not an intention-to-treat analysis because it was limited to surviving patients. (a) High-risk patients (n = 140). (b) Non-upper-lobe-predominant and low baseline exercise capacity (n = 149). (c) Non-upper-lobe-predominant and high baseline exercise capacity (n = 220). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A5 Mean change from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) among patients who completed the procedure 6 months and 1, 2, 3, 4, and 5 years after randomization to lung-volume-reduction surgery (LVRS, open circles) or medical treatment (filled circles) for (a) high-risk patients and (b–c) the lower-lobe-predominant subgroups of patients. Error bars represent the standard deviation of the distribution of changes. Shown below each graph are the numbers of patients evaluated and the mean change. This is not an intention-to-treat analysis because it was limited to surviving patients. (a) High-risk patients (n = 140). (b) Non-upper-lobe- predominant and low baseline exercise capacity (n = 149). (c.) Non-upper-lobe-predominant and high baseline exercise capacity (n = 220). The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A6 Histograms of changes from postrehabilitation baseline in exercise capacity (maximum work) for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 11, with higher scores indicating more improvement. Patients who were too ill to complete the procedure, who declined to complete the procedure, or who could pedal only with the ergometer set at 0 W were included in the missing category and scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A6 Histograms of changes from postrehabilitation baseline in exercise capacity (maximum work) for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 11, with higher scores indicating more improvement. Patients who were too ill to complete the procedure, who declined to complete the procedure, or who could pedal only with the ergometer set at 0 W were included in the missing category and scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A6 Histograms of changes from postrehabilitation baseline in exercise capacity (maximum work) for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 11, with higher scores indicating more improvement. Patients who were too ill to complete the procedure, who declined to complete the procedure, or who could pedal only with the ergometer set at 0 W were included in the missing category and scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A6 Histograms of changes from postrehabilitation baseline in exercise capacity (maximum work) for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 11, with higher scores indicating more improvement. Patients who were too ill to complete the procedure, who declined to complete the procedure, or who could pedal only with the ergometer set at 0 W were included in the missing category and scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A6 Histograms of changes from postrehabilitation baseline in exercise capacity (maximum work) for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 11, with higher scores indicating more improvement. Patients who were too ill to complete the procedure, who declined to complete the procedure, or who could pedal only with the ergometer set at 0 W were included in the missing category and scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A6 Histograms of changes from postrehabilitation baseline in exercise capacity (maximum work) for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 11, with higher scores indicating more improvement. Patients who were too ill to complete the procedure, who declined to complete the procedure, or who could pedal only with the ergometer set at 0 W were included in the missing category and scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A6 Histograms of changes from postrehabilitation baseline in exercise capacity (maximum work) for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 11, with higher scores indicating more improvement. Patients who were too ill to complete the procedure, who declined to complete the procedure, or who could pedal only with the ergometer set at 0 W were included in the missing category and scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A7 Histograms of changes from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) scores for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 9, with higher scores indicating more improvement. Patients who were too ill to complete the procedure or who declined to complete the procedure were included in the missing category and were scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High-risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A7 Histograms of changes from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) scores for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 9, with higher scores indicating more improvement. Patients who were too ill to complete the procedure or who declined to complete the procedure were included in the missing category and were scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High-risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A7 Histograms of changes from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) scores for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 9, with higher scores indicating more improvement. Patients who were too ill to complete the procedure or who declined to complete the procedure were included in the missing category and were scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High-risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A7 Histograms of changes from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) scores for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 9, with higher scores indicating more improvement. Patients who were too ill to complete the procedure or who declined to complete the procedure were included in the missing category and were scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High-risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A7 Histograms of changes from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) scores for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 9, with higher scores indicating more improvement. Patients who were too ill to complete the procedure or who declined to complete the procedure were included in the missing category and were scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High-risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A7 Histograms of changes from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) scores for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 9, with higher scores indicating more improvement. Patients who were too ill to complete the procedure or who declined to complete the procedure were included in the missing category and were scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High-risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig A7 Histograms of changes from postrehabilitation baseline in health-related quality of life (St. George’s Respiratory Questionnaire) scores for (a) all patients and (b–g) among the subgroups of patients. The change from baseline for each survivor completing the procedure was scored 2 to 9, with higher scores indicating more improvement. Patients who were too ill to complete the procedure or who declined to complete the procedure were included in the missing category and were scored 1. Patients who died were scored 0. The p values were determined from the Wilcoxon rank-sum test. The degree to which the bars are shifted to the upper left of the chart indicates the degree of relative benefit of LVRS over medical treatment. The percentage shown in each quadrant is the percentage of patients with a change in the outcome falling into that quadrant. This is an intention-to-treat analysis. (a) All patients. (b) High-risk patients. (c) Non-high-risk patients. (d) Upper-lobe-predominant and low baseline exercise capacity. (e) Upper-lobe-predominant and high exercise capacity. (f) Non-upper-lobe-predominant and low exercise capacity. (g) Non-upper-lobe-predominant and high exercise capacity. The Annals of Thoracic Surgery 2006 82, 431-443.e19DOI: (10.1016/j.athoracsur.2006.05.069) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions