Utilization Trends, Outcomes, and Cost in Minimally Invasive Lobectomy.

Abstract

BACKGROUND\nMinimally invasive lobectomy is associated with decreased morbidity and length-of-stay. However, there have been few published analyses using recent, population-level data to compare clinical outcomes and cost by surgical approach, inclusive of robotic-assisted thoracic surgery (RATS). The objective of this study was to compare outcomes and hospitalization costs in patients undergoing open, video-assisted thoracoscopic surgery (VATS), and RATS lobectomy.\n\n\nMETHODS\nWe identified patients who underwent elective lobectomy in the Healthcare Cost and Utilization Project Florida State Inpatient Database (2008-2014). Hierarchical logistic and linear regression models were used to compare in-hospital mortality, postoperative complications, prolonged length-of-stay (LOS), 30-day readmissions, and index hospitalization costs among cohorts.\n\n\nRESULTS\nWe identified 15,038 patients, of which 8501 (56.5%), 4608 (30.7%), and 1929 (12.8%) underwent open, VATS, and RATS lobectomy, respectively. Robotic-assisted lobectomies comprised <1.0% of total lobectomy volume in 2008, and grew to 25.0% of lobectomy volume by 2014. VATS and RATS lobectomy were associated with decreased in-hospital mortality compared to thoracotomy (VATS: OR: 0.69 (95% CI: 0.50-0.94), RATS: OR: 0.58 (95% CI: 0.35-0.96), p=0.016). After adjusting for patient age, gender, income, comorbidities, and hospital teaching status, VATS lobectomy was 2% less expensive (p=0.007) and robotic-assisted lobectomy was 13% more expensive (p<0.001) than the open approach.\n\n\nCONCLUSIONS\nMinimally invasive approaches were associated with improved clinical outcomes compared to open lobectomy. However, only robotic-assisted lobectomy has experienced rapid growth in utilization. Despite additional cost, RATS lobectomy appears to provide a viable minimally invasive alternative for general thoracic procedures.