Comparison Of Healthcare Utilization And Outcomes Of Video Assisted Thoracoscopic Surgery With Thoracotomy In Lung Lobectomy Surgery
David Wei1, Sanjoy Roy2, Sudip Ghosh3, Edmund Kassis3, Iftekhar Kalsekar1.
1Johnson & Johnson, Co, New Brunswick, NJ, USA, 2Ethicon Inc., a Johnson & Johnson company, Soverville, NJ, USA, 3Ethicon Inc., a Johnson & Johnson company, Cincinnati, OH, USA.
OBJECTIVE: Video assisted thoracoscopic surgery (VATS) has been established as a minimally invasive alternative for major lung lobectomy surgery. However, there is a lack of broad-based data about hospital level healthcare utilization and costs associated with VATS, compared to traditional thoracotomy. The objective of this study is to assess the impact of surgical approach on outcomes such as total hospital costs, length of stay (LOS), operating room time (ORT), discharge status, and most frequent complications in real world settings.
METHODS: The study was conducted using the nationally representative Premier Perspective database of hospital discharges in the US. Included patients were 18 years of age or older and had an elective lung lobectomy from 01/2008 to 12/2014. Multivariable models controlling for patient, provider and procedure specific characteristics were used to estimate the adjusted impact of approach on outcomes.
RESULTS: A total of 22,946 patients underwent elective lung lobectomy with an average age of 66.6 (18-89) years. Of these, 57.2% (n=13,114) had open surgery, and 42.8% (n=9,832) attempted VATS (including procedures that were converted to open). Adjusted total in-hospital costs were $24,918 (95% CI: $23,871-$26,010) for VATS patients, and $27,790 (95% CI: $26,727-$28,895) for open patients, respectively (p<0.0001). Room and board cost contributed primarily to this difference. VATS patients had shorter (p<0.0001) length of stay, 6.5 days (95% CI: 6.2-6.7), than open patients, 8.0 days (95% CI: 7.8-8.2). The operating room time was almost the same for VATS and open patients, 242.5 vs 242.1 minutes. VATS patients were 36.5% less likely to be discharged to skilled nursing facility (SNF) (odds ratio: 0.634, 95% CI: 0.556-0.724), and 21.3% less likely to have one of the 10 most frequently occurring complications (OR: 0.787, 95% CI: 0.711-0.870). The in-hospital mortality between the two groups did not differ significantly (OR: 0.831, 95% CI: 0.661-1.045).
CONCLUSIONS: Video assisted thoracoscopic surgery (VATS) required shorter length of stay, and incurred lower hospital cost than traditional open lobectomy. This minimally invasive surgical approach also was associated with reduced discharge to skilled nursing facility, and lower risks of complication.
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