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Impact Of Geographic And Sociodemographic Factors On The Utilization Of Robotic-assisted Lung Resection Versus Video-assisted Lung Resection
Aaron R. Dezube1, Michael Dezube
2, Natasha K. Valas
1, Virginia R. Litle
1;
1St Elizabeth Medical Center, Brighton, MA, USA,
2Massachusetts General Hospital, Boston, MA, USA
BACKGROUND: Robotic-assisted thoracoscopic surgery (RATS) has become an accepted and widely used approach to lung resection. We hypothesized that geographic and sociodemographic factors would impact trends in the utilization of RATS versus video-assisted thoracoscopic surgery (VATS) for lung resection in the United States.
METHODS: The National Inpatient Sample was queried for patients who underwent RATS and VATS lung resection between 2016-2020 for benign or malignant neoplasms and nodules. Cohorts were then stratified by degree (lobectomy vs. sublobar) and technique (RATS vs. VATS) of resection and compared with respect to pretreatment variables including sociodemographic, hospital-level, and geographic factors.
RESULTS: From 2016-2020, 81,360 patients underwent lobectomy (35.7% vs. 64.3% for RATS and VATS respectively) and 88,620 underwent sub-lobar resection (24.2% vs 75.8% for RATS and VATS respectively). Rates of RATS lung resection increased annually, with the rate of increase varying by geographic hospital division (Figure 1). A significant difference in sociodemographic, hospital-level, and geographic variables was present between the RATS and VATS cohorts (all p<0.05). The nine geographic hospital divisions showed statistically significant differences in utilization of RATS. The odds ratios (OR) with respect to East South Central for lobectomies ranged between 1.64 (95% CI: 1.35-2.0) for Pacific to OR 3.88 (95% CI: 3.23-4.67) for East North Central. For sublobar resection with respect to East South Central, odds ratios ranged between OR 1.64 (95% CI 1.31-2.06) for Pacific to OR 3.27 (95% CI 2.69-4.02) for South Atlantic. Furthermore, patient factors, including race, age, insurance, and hospital factors, such as geographic location, teaching status, and size, were associated with variable odds of RATS utilization for lobectomy (p<0.05). These findings were largely similar in RATS utilization for sublobar resection except for insurance status (p>0.05).
CONCLUSIONS:Even after adjusting for sociodemographic factors, there were significant geographic regional differences in RATS utilization over VATS for lung resection, with overall rates of RATS utilization ranging from 16.9% to 44.7% for lobectomy and 11.5% to 30.6% for sublobar lung resection between different geographic regions.
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