Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer

Mafé, Juan José; Planelles, Beatriz; Sánchez, Santos Asensio; Cerezal, Jorge; Inda, María-del-Mar; Lacueva, Javier; Esteban, Maria J.; Hernández, Luís; Martín, César Casquet; Baschwitz, Benno; Peiró, A. Maestre

doi:10.21037/jtd.2017.07.51

Cited by 12 publications

(13 citation statements)

References 33 publications

(22 reference statements)

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“…This finding, as well as the finding of lower total hospital costs, is consistent with a previous real-world study of patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy, wherein the use of powered staplers vs. manual staplers was associated with a lower rate of bleeding/transfusion and lower total hospital costs [ 14 ]. It should be noted that the rate of hemostasis-related complications in the present study is higher than reported in the clinical literature [ 3 , 4 , 7 ]. The higher rate of hemostasis-related complications in the present study is likely driven by differences in the method of ascertainment of these complications (coding vs. clinical observation).…”

Section: Discussioncontrasting

confidence: 75%

“…The video-assisted thoracic surgery (VATS) approach has emerged as a superior option in comparison with open thoracotomy because of benefits to patients associated with the minimally invasive technique [ 1 – 7 ]. Studies have consistently shown that VATS lobectomy is associated with lower complication rates and morbidity when compared with open thoracotomy [ 1 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have consistently shown that VATS lobectomy is associated with lower complication rates and morbidity when compared with open thoracotomy [ 1 – 4 ]. Additionally, recently published series of cancer patients showed that VATS lobectomy was associated with less postoperative pain, improved quality of life, and similar hospital costs when compared with open thoracotomy [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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: Discussioncontrasting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…In this study, we found that the VATS approach was more expensive than the open approach. Several previous reports have demonstrated that the costs of VATS lobectomy were lower than open thoracotomy because of shorter hospital stay (21)(22)(23)(24)(25)(26)(27). Most of these studies were from developed countries.…”

Section: Discussionmentioning

confidence: 99%

Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Mei¹,

Guo²,

Xia³

et al. 2019

Transl. Lung Cancer Res

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Background: Video-assisted thoracic surgery (VATS) has been considered as the better choice for the surgical treatment of resectable non-small cell lung cancer (NSCLC). This study aimed to evaluate the short-and long-term outcomes of VATS versus open thoracotomy lobectomy for patients with pathological stage (p-stage) I-II NSCLC in one of the high-volume center in China. Methods: Perioperative outcomes and long-term survival of patients who underwent VATS versus open lobectomies for p-stage I-II NSCLC from May 2006 to June 2013 in the Western China Lung Cancer Database (WCLCD) were studied using propensity score matching (PSM). The VATS lobectomy was mainly carried out using the single-direction technique. Results: Of the 3,678 patients who underwent surgery for lung malignancies, 1,485 patients with stage I-II NSCLC were enrolled for the study, including 737 cases of VATS lobectomies and 748 cases of open lobectomies. PSM resulted in 464 cases of VATS lobectomies and 464 cases of open lobectomies who were well matched by ten potential prognostic factors including tumor size, T-and N-stage. VATS lobectomy was associated with less blood loss than open surgery (median: 60 vs. 100 mL, P=0.000), as well as fewer postoperative complications (15.1% vs. 20.3%, P=0.039). In addition, the VATS approach removed more lymph node stations (4.9±1.5 vs. 4.2±1.8, P=0.000). The postoperative hospital stay was shorter in the VATS group (7.7±3.8 vs. 8.3±4.3, P=0.019), but the total hospital costs were more expensive (48.4±11.3 vs. 35.5±9.4 kRMB, P=0.000). The matched cohorts revealed that VATS lobectomy for stage I-II NSCLC had improved 5-year overall survival (OS) than the open approach (71.1% vs. 65.4%, P=0.045). Conclusions: The VATS lobectomy is associated with less blood loss, fewer postoperative complications, and shorter postoperative hospital stay when comparing with the open approach for stage I-II NSCLC. Despite more hospital costs, VATS lobectomy offer improved 5-year OS than the open approach. It is reasonable to recommend the VATS approach as the preferred option for the surgical treatment of stage I-II NSCLC.

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“…These results parallel other studies demonstrating decreased length of stay with equivalent results when comparing VATS lobectomy vs. open approach. In addition to demonstrating oncologic equivalence, minimally invasive approaches demonstrate decreased costs, secondary to decreased length of stay that make up for increased operating room time and instrument costs (14,15). Likewise, there was decreased rate of discharges requiring further skilled healthcare, representing an additional significant cost savings to the health care system (16).…”

Section: Discussionmentioning

confidence: 99%

Saving the split: the benefits of VATS thymectomy

et al. 2019

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Background: With the advent of minimally invasive techniques, the standard approaches to many surgeries have changed. We compared the financial costs and health care outcomes between standard thymectomy via sternotomy and video assisted thoracoscopic surgery (VATS). Methods: A 3-year review [2010-2012] of the National Inpatient Sample (NIS) was performed. All patients undergoing thymectomy were included. Patients undergoing VATS thymectomy were identified. Outcomes measured were hospital length of stay (LOS), hospital charges, and mortality. Univariate and multivariate analyses were performed to control for demographics and comorbidities. Results: The results of 2,065 patients who underwent thymectomy were analyzed, of which 373 (18.1%) had VATS thymectomy and 1,692 (81.9%) had standard thymectomy. Mean age was 52.8±16, 42.5% were male, and 65.5% were Caucasian. There was a significant interval increase in number of patients undergoing VATS thymectomy (10% in 2010 vs. 19.2% in 2012, P<0.001). Patients undergoing standard thymectomy had longer hospital LOS (6.8±6.6 vs. 3.3d±3.4 d, P<0.

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Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer

Cited by 12 publications

References 33 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

Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Saving the split: the benefits of VATS thymectomy

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