Back to 2017 Thoracic Track Overview

Objective:
In a quality and cost conscious environment, programs that a) improve patient outcomes, b) decrease costly utilization and c) deliver revenue are considered high value programs. This study evaluated these aspects of an application of robotic surgical technology and a low dose computed tomography (LDCT) program in a community hospital from 2013 to 2016.
Methods:
Quality evaluations included: 1) retrospective review of lung resection outcomes, 2) retrospective evaluation of lung cancer stage at presentation and 3) retrospective review of surgical nodal evaluation and subsequent clinical upstaging.
The cost value of these programs was examined by a) assessing the financial impact of a program on resource utilization and b) calculation of actual revenue generated, including valuation of program growth.
Results:
Conversion from thoracotomy to robotics for lung resection improved patient outcomes in length of stay LOS), complications, 30-day mortality and intensive care unit (ICU) utilization, as shown.^1,2 Quality considerations in oncology showed an increase in stage I identification from 26% in 2013, the first full year of LDCT program, to 34% in 2016. Increased attention to surgical nodal evaluation was associated with improved pathologic upstaging and stage-appropriate therapy.
Resource utilization decreased in two areas: ICU and hospital use secondary to outcomes improvement, and overall system due to earlier cancer stage detection. As noted, the outcomes improvement transformed resection from a “loss leader” (-$1300/patient) to net revenue of $2917/patient.³ The noted 8% increase in early stage detection represented 16 patients. The savings in early stage versus late stage treatment is estimated at $375,648.⁴
The LDCT program completed over 800 initial scans. Net revenue was $550,000 and revenue from subsequent follow-up exceeded 1 million dollars. Concurrently thoracic resections increased by 64%. The net revenue from this growth exceeded 1 million dollars.
Conclusion:
Successful application of thoracic robotic surgery coupled with an LDCT program is a strong value proposition in a community hospital. Significant, measureable quality improvements, decreased resource utilization and positive revenue achievements can be expected.

Table 1: Quality Improvements

Quality Parameter	Thoracotomy (n=125)	Robotic Resection (n=225)
Length of Stay (p < 0.01)	6.1 days	3.7 days
Major Complication (p < 0.05)	18.4 %	8.4%
30-day Mortality (p < 0.05)	2.4%	0.4%
ICU Utilization (p < 0.05)	87.2%	3.1%
Mean Node Number (p < 0.05)	6	16.3
Mean Nodal Stations	N1 - 1.4, N2 - 1	N1 - 2.0, N2 -2.4
Upstaging (p < 0.05)	7.2%	18.7%