A retrospective study using the US Medicare database compared outcomes for patients with advanced emphysema who underwent endobronchial valve (EBV) therapy vs lung volume reduction surgery (LVRS). After risk adjustment, EBV was associated with higher 30-day mortality, 30-day readmissions, reinterventions, and one-year all-cause mortality rates, despite shorter hospital stays and lower costs compared to LVRS. Most surgeries were minimally invasive, and these findings suggest a need to reevaluate the use of EBV relative to surgery, as EBV patients experienced worse risk-adjusted survival and morbidity outcomes despite having fewer baseline comorbidities than those who underwent LVRS.