Video-Assisted Thoracoscopic versus Open Lobectomy: Costs and Outcomes

Rodgers-Fischl, Peter; Martin, Jeremiah T.; Saha, Sibu P.

doi:10.14423/smj.0000000000000620

Cited by 18 publications

(16 citation statements)

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“…In the primary and post hoc subanalyses, powered staplers (overall, Ethicon, and Ethicon PVS) were associated with 13.6–17.1% shorter length of stay as compared with manual staplers (overall, Medtronic). Although there are no prior published studies to which we can compare these specific results, the present study’s average hospital LOS (4.7–5.7 days) are in the range of that reported in other US studies [ 6 , 23 , 24 ]. For example, among patients who underwent VATS lobectomy at the University of Kentucky Chandler Medical Center in years 2013–2014, the average hospital LOS was 5.5 days [ 6 ].…”

Section: Discussionsupporting

confidence: 63%

Impact of Powered and Tissue-Specific Endoscopic Stapling Technology on Clinical and Economic Outcomes of Video-Assisted Thoracic Surgery Lobectomy Procedures: A Retrospective, Observational Study

Miller¹,

Roy²,

Kassis³

et al. 2018

Adv Ther

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IntroductionVideo-assisted thoracic surgery (VATS) lung resections are complex procedures with a critical role played by endoscopic staplers in the transection of vessels, bronchi, and lung tissue. This retrospective, observational study compared hospital resource use, costs, and complications of VATS lobectomy procedures for whom powered versus manual endoscopic surgical staplers were used.MethodsPatients ≥ 18 years of age undergoing elective VATS lobectomy during an inpatient admission from January 1, 2012 to September 30, 2016 were identified from the Premier Healthcare Database (first admission = index admission). Use of either powered or manual endoscopic staplers during the index admission was identified from hospital administrative records. Multivariable regression analyses adjusting for patient, hospital, and provider characteristics and hospital-level clustering were carried out to compare the following outcomes between the powered and manual stapler groups: hospital length of stay (LOS), operating room time (ORT), hospital costs, complications (bleeding and/or transfusions, air leak complications, pneumonia, and infection), discharge status, and 30-, 60-, and 90-day all-cause readmissions.ResultsThe powered and manual stapler groups comprised 659 patients (mean age 66.1 years; 53.6% female) and 3100 patients (mean age 66.7 years; 54.8% female), respectively. In the multivariable analyses, the powered stapler group had shorter LOS (4.9 vs. 5.9 days, P < 0.001), lower total hospital costs ($23,841 vs. $26,052, P = 0.009), and lower rates of combined hemostasis complications (bleeding and/or transfusions; 8.5% vs. 16.0%, P < 0.001) and transfusions (5.4% vs. 10.9%, P = 0.002), compared with the manual stapler group. Other outcomes did not differ significantly between the study groups. Similar trends were observed in subanalyses comparing devices across predominant manufacturers in each group, and in subanalyses of patients with comorbid chronic obstructive pulmonary disease.ConclusionIn this analysis of VATS lobectomy procedures, powered staplers were associated with significant benefits with respect to selected types of hospital resource use, costs, and clinical outcomes when compared with manual staplers.FundingJohnson & Johnson.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0679-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 63%

Impact of Powered and Tissue-Specific Endoscopic Stapling Technology on Clinical and Economic Outcomes of Video-Assisted Thoracic Surgery Lobectomy Procedures: A Retrospective, Observational Study

Miller¹,

Roy²,

Kassis³

et al. 2018

Adv Ther

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“…Swanson et al showed similar results and conclusions in their study from 2012, although they disregarded the initial costs of the equipment for VATS [24]. In a retrospective database-review Rodgers-Fischl et al found costs associated with VATS did not vary significantly from thoracotomy, and therefore concluded that in their institution VATS was equivalent to thoracotomy in terms of costs [25].…”

Section: Discussionmentioning

confidence: 68%

Cost–utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial

Bendixen

Kronborg

Jørgensen

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: Minimally invasive video-assisted thoracic surgery (VATS) was first introduced in the early 1990s. For decades, numerous non-randomized studies demonstrated advantages of VATS over thoracotomy with lower morbidity and shorter hospital stay, but only recently did a randomized trial document that VATS results in lower pain scores and better quality of life. Opposing arguments for VATS have always been increased costs and concerns about oncological adequacy. In this paper, we aim to investigate the cost-effectiveness of VATS. METHODS: The study was designed as a cost–utility analysis of the first 12 months following surgery and was performed together with a clinical randomized controlled trial of VATS versus thoracotomy for lobectomy of stage 1 lung cancer during a 6-year period (2008–2014). All health-related expenses were retrieved from a national database (Statistics Denmark) including hospital readmissions, outpatient clinic visits, prescription medication costs, consultations with general practitioners, specialists, physiotherapists, psychologists and chiropractors. RESULTS: One hundred and three VATS patients and 103 thoracotomy patients were randomized. Mean costs per patient operated by VATS were 103 108 Danish Kroner (Dkr) (€13 818) and 134 945 Dkr (€18 085) by thoracotomy, making the costs for VATS 31 837 Dkr (€4267) lower than thoracotomy (P < 0.001). The difference in quality-adjusted life years gained over 52 weeks of follow-up was 0.021 (P = 0.048, 95% confidence interval −0.04 to −0.00015) in favour of VATS. The median duration of the surgical procedure was shorter after thoracotomy (79 vs 100 min; P < 0.001). The mean length of hospitalization was shorter following VATS (4.8 vs 6.7 days; P = 0.027). The use of other resources was not significantly different between groups. The costs of resources were lower in the VATS group. This difference was primarily due to reduced costs of readmissions (VATS 29 247 Dkr vs thoracotomy 51 734 Dkr; P < 0.001) and costs of outpatient visits (VATS 51 412 Dkr vs thoracotomy 61 575 Dkr; P = 0.012). CONCLUSIONS: VATS is a cost-effective alternative to thoracotomy following lobectomy for stage 1 lung cancer. Economical outcomes as measured by quality-adjusted life years were significantly better and overall costs were lower for VATS. Clinical Trial Registration Number: NCT01278888.

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“…Our data also show that when cost-conscious intraoperative decisions are made by surgeons, total in-hospital costs of VATSL can be safely reduced to well below the inhospital costs of THORL. Because studies have been inconsistent in demonstrating total in-hospital cost benefits for VATSL over THORL, [11][12][13][14][15] our work provides an explanation for the often higher intraoperative costs associated with VATSL. 14,16,17 Furthermore, given the lower postdischarge costs after VATSL than after THORL, 11,12 our findings suggest that overall costs of the entire episode of care surrounding VATSL will be substantially lower than those of THORL if surgeons make cost-conscious intraoperative decisions.…”

Section: Discussionmentioning

confidence: 81%

“…[1][2][3][6][7][8][9][10] Economic analyses have determined that postdischarge costs are lower after VATSL than after THORL, 11,12 but have been inconsistent in finding an in-hospital cost benefit for VATSL. [11][12][13][14][15] Several studies have suggested that the greater intraoperative costs of VATSL compared with THORL is why overall hospital costs have not been lower for VATSL. 14,16,17 Given the strong shift toward value-based health care, we sought to determine whether the higher intraoperative costs of VATSL compared with THORL 14,16,17 can be favorably impacted by surgeons' intraoperative choices and, if so, whether these more cost-effective choices can be made without adversely affecting outcomes.…”

Section: See Editorial Commentary Page 1278mentioning

confidence: 99%

Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes

Richardson

Backhus

Berry

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Video-Assisted Thoracoscopic versus Open Lobectomy: Costs and Outcomes

Cited by 18 publications

References 0 publications

Impact of Powered and Tissue-Specific Endoscopic Stapling Technology on Clinical and Economic Outcomes of Video-Assisted Thoracic Surgery Lobectomy Procedures: A Retrospective, Observational Study

Impact of Powered and Tissue-Specific Endoscopic Stapling Technology on Clinical and Economic Outcomes of Video-Assisted Thoracic Surgery Lobectomy Procedures: A Retrospective, Observational Study

Cost–utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial

Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes

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