Economic Impact Associated With In-hospital Complications Of Pulmonary Lobectomy Via Open Thoracotomy Or Minimally Invasive Surgery
David Wei1, Pierre Theodore2, Stephen Johnston1, Anuprita Patkar2.
1Johnson and Johnson, New Brunswick, NJ, USA, 2Ethicon, Somerville, NJ, USA.
OBJECTIVE: Peri-operative complications associated with lobectomy are implicated in clinical outcomes. However, there is limited of real-world data about the costs associated with such complications. This study described the rate of selected in-hospital complications and their associated impact on total hospital costs among patients undergoing pulmonary lobectomy surgery in a variety of clinical settings. METHODS: Detailed hospital discharge records for the period 2010-2017 were retrospectively reviewed using the Premier Healthcare Database, a national administrative database from over 700 hospitals in the U.S. Inclusion criteria were: age ≥18 years and lobectomy in study period. Complications were identified by the presence of reported ICD-9-CM/10-CM diagnosis codes. Multivariable regressions were used to examine the association between the selected in-hospital complications and total hospital costs (inflation adjusted to 2017 USD), adjusting for patient and provider/hospital characteristics. Separate models were fitted for different surgical approaches (open thoracotomy[OT], video-assisted thoracoscopic lobectomy[VATS], and robot-assisted thoracic surgery[RATS]). RESULTS: A total of 34,334 patients underwent pulmonary lobectomy during the period reviewed with an average age of 66.3 (range: 18-89) years (Table 1). Of these, 53.3% (n=18,306) had OT, 37.1% (n=12,745) had VATS, and 9.6% (n=3,283) had RATS. Of the selected complications, the most common (rates in OT, VATS, and RATS) were air leak and pneumothorax (26.3%, 24.5%, 24.3%), respiratory failure (23.3%, 15.8%, 14.2%), dysrhythmias (16.2%, 12.4%, 10.7%), and bleeding (13.2%, 8.0%, and 4.8%), respectively. Multivariable-adjusted incremental total hospital costs for in-hospital complications were: air leak and pneumothorax, $3,368(OT), $3,779(VATS), $3,857(RATS); respiratory failure, $6,994(OT), $5,542(VATS), and $4,039(RATS); dysrhythmias, $3,989(OT), $3,800(VATS), $3,817(RATS); bleeding $3,791(OT), $4,312(VATS), $3,838(RATS). These complications were also associated with an increased length of stay (LOS). All incremental total hospital cost and LOS increases were statistically significant (p<0.001). CONCLUSIONS: This study suggests that the complication rates in lung lobectomy were substantial, and resulted in significant increases in hospital costs and LOS, and varied by surgical approach. These results can help inform decision making regarding hospital procedure approaches and adopting strategies to mitigate peri-operative complications.
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