Video-Assisted Thoracoscopic Lobectomy Is Less Costly and Morbid Than Open Lobectomy: A Retrospective Multiinstitutional Database Analysis

doi:10.1016/j.athoracsur.2011.06.007

The Annals of Thoracic Surgery

Volume 93, Issue 4, April 2012, Pages 1027-1032

Presented at the Poster Session of the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.

https://doi.org/10.1016/j.athoracsur.2011.06.007 Get rights and content

Background

The Premier Perspective Database (Premier Inc, Charlotte, NC) was used to compare hospital costs and perioperative outcomes for video-assisted thoracoscopic surgery (VATS) and open lobectomy procedures in the United States.

Methods

Eligible patients underwent a lobectomy for cancer by a thoracic surgeon, by VATS or open thoracotomy and were captured in the database between third quarter of 2007 and through 2008. Multivariable logistic regression analyses were performed for binary outcomes. Ordinary least-squares regressions were used to estimate continuous outcomes. All models were adjusted for patient and hospital characteristics.

Results

A total of 3,961 patients underwent a lobectomy by a thoracic surgeon by open (n = 2,907) or VATS (n = 1,054) approach. Hospital costs were higher for open versus VATS; $21,016 versus $20,316 (p = 0.027). Adjustment for surgeon experience with VATS over the 6 months prior to each operation showed a significant association between surgeon experience and cost. Average costs ranged from $22,050 for low volume surgeons to $18,133 for high volume surgeons. For open lobectomies, cost differences by surgeon experience were not significant and both levels were estimated at $21,000. Length of stay was 7.83 versus 6.15 days, for open versus VATS (p = 0.000). Surgery duration was shorter for open procedures at 3.75 versus 4.09 for VATS (p = 0.000). The risk of adverse events was significantly lower in the VATS group, odds ratio of 1.22 (p = 0.019).

Conclusions

Lobectomy performed by the VATS approach as compared with an open technique results in shorter length of stay, fewer adverse events, and less cost to the hospital. Economic impact is magnified as the surgeon's experience increases.

Section snippets

Material and Methods

A protocol describing the analysis objectives, criteria for patient selection, data elements of interest, and statistical methods was submitted to the New England Institutional Review Board. Exemption was obtained.

Results

Of 8,228 patients in the database with elective, inpatient resections for lung cancer, 3,961 patients underwent lobectomy by a thoracic surgeon using either an open technique (n = 2,907) or a VATS approach (n = 1,054). A patient attrition diagram is shown in Figure 1. Characteristics of eligible patients are summarized in Table 1. There were more females than males in both groups, and most patients were over 60 years of age and covered by Medicare. Most patients were Caucasian, with primary (as

Comment

In this retrospective analysis of a large, nationally representative database of more than 600 hospitals, VATS lobectomies for lung cancer were performed in approximately one-half of all hospitals and one-quarter of all patients undergoing lobectomy for cancer. Patients with VATS lobectomy had significantly shorter lengths of stay and lower hospital costs than patients undergoing open lobectomy for lung cancer. These differences persisted even after adjusting for potentially important

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Original articleGeneral thoracicVideo-Assisted Thoracoscopic Lobectomy Is Less Costly and Morbid Than Open Lobectomy: A Retrospective Multiinstitutional Database Analysis

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Original article
General thoracic
Video-Assisted Thoracoscopic Lobectomy Is Less Costly and Morbid Than Open Lobectomy: A Retrospective Multiinstitutional Database Analysis