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

Richardson, Michael; Backhus, Leah M.; Berry, Mark F.; Vail, Daniel; Ayers, Kelsey; Benson, Jalen; Bhandari, Prasha; Teymourtash, Mehran; Shrager, Joseph B.

doi:10.1016/j.jtcvs.2017.08.146

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…Although we observed a lower cost for videothoracoscopic anatomic resections, the cost of VATS lobectomy was shown to be possibly further reduced through the prudent use of costly instruments and technologies. [9] Bendixen and colleagues performed a randomized study and reported that VATS is a cost-effective alternative to thoracotomy in stage 1 non-small cell lung cancer patients. [10] We were able to show that VATS is cost-effective in patients with stage IA-IIIA non-small cell lung cancer.…”

Section: Discussionmentioning

confidence: 99%

VATS cost is less than thoracotomy in operable NSCLC patients

Turna¹

2022

Eurasian J Pulmonol

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BACKGROUND AND AIM:Better management of financial resources provided by the government-based insurance system is one of the important challenges in the administration of hospitals. The aim of this study was to compare videothoracoscopic surgery and open thoracotomy regarding cost and hospital stay. METHODS:Eighty-eight patients who underwent video-assisted thoracoscopic surgery (VATS) or open thoracotomy for operable (stage IA-IIIA) non-small cell lung cancer were analyzed retrospectively. The general cost of hospital treatment, cost of operation, and cost of hospital stay of these patients were compared. RESULTS:A total of 48 lobectomies, 33 wedge resections, 2 segmentectomies, and 5 pneumonectomies were analyzed. Fifty-eight patients (65.9%) underwent VATS resection, and 30 patients (34.1%) had resection via open thoracotomy. There was no statistically significant difference in terms of gender, age, and pulmonary function test between the groups. The postoperative hospital stay, intensive care unit stay, was higher in patients who underwent thoracotomy compared with patients who underwent VATS (p=0.006 vs p=0.02). The total hospital cost and the cost of operation for patients operated via VATS were lower compared with the costs for patients operated via thoracotomy (p=0.026 vs p=0.014). When analyzed separately, the cost of VATS lobectomy was lower than that of lobectomy via thoracotomy; however, the difference was not statistically significant (p=0.114). CONCLUSIONS:The total hospital cost and the cost of operation via VATS are lower than the costs of thoracotomy. VATS also leads to a reduced hospital stay. VATS should be considered the gold standard in resectional surgery in patients who need lobectomy, segmentectomy, or wedge resection.

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Section: Discussionmentioning

confidence: 99%

VATS cost is less than thoracotomy in operable NSCLC patients

Turna¹

2022

Eurasian J Pulmonol

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“…Thus, in the absence of documented Harmonic ACE Plus® greater impact on the surgical procedure and on postoperative short-term outcomes, electric hook may be preferred with the aim of saving direct cost of the energy device. However, ultrasonic device sealing ability could reduce the use of endoscopic staplers and ligating clips, that are also costly, and may impact on overall surgical costs [9,14,16,18,20].…”

Section: Discussionmentioning

confidence: 99%

Energy devices safety and impact on video-assisted thoracoscopic lung lobectomy postoperative course: monopolar electrocautery versus ultrasonic dissector

Cattoni

Rotolo

Nardecchia

et al. 2021

J Cardiothorac Surg

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Background This study aims to compare safety and impact of monopolar electrocautery and ultrasonic dissector (Harmonic ACE Plus®) on postoperative short-term outcomes after video-assisted thoracoscopic (VATS) lobectomy and lymphadenectomy for lung cancer. Methods We analyzed the prospectively collected data of 140 consecutive patients [59% male; median age: 71(IQR:62–76) years] undergoing VATS lobectomy and lymphadenectomy in our institution between October 2016 and November 2019. Patients were divided in two groups based on device used: monopolar electric hook in 79 cases (Group A); ultrasonic dissector in 61(Group B). Energy instrument-related intraoperative accidents, hemothorax/chylothorax incidence, total pleural effusion volume at 48 postoperative hours and chest tube duration were compared between groups. Multivariable analysis was performed to test energy device as possible independent risk factor either for increased pleural effusion volume or for prolonged chest tube duration. Results No intraoperative accidents due to energy device occurred. No hemothorax was recorded. Postoperative chylothorax incidence was slightly higher in Group A (2.5% vs 0%; p-value = 0.21). Total pleural effusion volume at 48 h was significantly higher in Group B: 400 (285–500) vs 255 (150–459) ml (p-value = 0.005). Chest tube duration was similar in the two groups: 5 (3–9) vs 5 (3–8) days (p-value = 0.77). At multivariable analysis the energy device used was not associated with increased pleural effusion volume (p-value = 0.43) nor with prolonged chest tube duration (p-value = 0.28). Conclusions Monopolar electrocautery and Harmonic ACE Plus® were safe and had a similar impact on short-term outcomes after VATS lobectomy and lymphadenectomy, suggesting that energy devices choice could be left to surgeon’s preference.

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“…It concludes that these choices are the main driver of cost variation between the 2 surgeons (whose outcomes were similar). 3 Despite the limited scope of this study, the concept of such comparisons is critical if we are soon to make judgments regarding the cost-effectiveness of robotics versus thoracoscopic thoracic surgery, or regionalizing some surgical procedures (such as esophagogastrectomy), or implementing other new technologies into surgical practice. The specific conclusions of this study are not as important as the process in which surgeons are aware of their own cost per case.…”

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confidence: 99%