Utilization Trends, Outcomes, and Cost in Minimally Invasive Lobectomy

Subramanian, Melanie P.; Liu, Jingxia; Chapman, William C.; Olsen, Margaret A.; Yan, Yan; Liu, Ying; Semenkovich, Tara R.; Meyers, Bryan F.; Puri, Varun; Kozower, Benjamin D.

doi:10.1016/j.athoracsur.2019.06.049

Cited by 52 publications

(48 citation statements)

References 15 publications

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“…They analyzed data from 697 patients operated by RATS (n = 296), VATS (n = 161), and open (n = 240) for a lobectomy between 2012 and 2017 and performed a propensity score adjustment. Unlike our report [46] , and that of Subramanian et al [48] , the overall cost -including operating room costs and in-hospital costs -of the three approaches were similar: RATS $17,223, VATS $17,260, and open $18,075 (P = 0.48). Nevertheless, RATS and VATS approaches were associated with higher operating room costs -RATS $9912 and VATS $9491 -compared to open thoracotomy -$8698 (P = 0.001).…”

Section: Discussioncontrasting

confidence: 75%

“…Conversely, VATS was found to be a cost-effective alternative compared to thoracotomy in the randomized controlled trial of Bendixen et al [47] , with a savings of €4267 (P < 0.001). Subramanian et al [48] reported that, compared to open lobectomy, RATS lobectomy was 13% more expensive (P < 0.001) and VATS lobectomy 2% less expensive (P = 0.007). In their report, they analyzed operating room costs and in-hospital costs from patients operated between 2008 and 2014 in Florida, with data from the Healthcare Cost and Utilization Project Florida State Inpatient Database.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, according to their experience, despite the higher operating room costs calculated for RATS and VATS, it was recovered by postoperative costs reductions associated with improved postoperative outcomes and shorter hospital stay (P < 0.001). These three articles [46,48,49] reported higher operating room costs for RATS lobectomy but compensated by improved outcomes compared to thoracotomy. Nevertheless, RATS will always be more expensive, and our goal is to reduce this economic gap.…”

Section: Discussionmentioning

confidence: 99%

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Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

Montagne¹,

Bottet²,

Sarsam³

et al. 2020

MIS

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More and more data are available on the benefits of minimally invasive thoracic surgery compared to open thoracic surgery in the curative treatment of early-stage non-small cell lung cancer. However, results are conflicting, especially when video-assisted thoracoscopic surgery (VATS) is compared to robotic-assisted thoracoscopic surgery (RATS) for lobectomy. Our goal is to report the main results of recent systematic reviews and meta-analyses comparing RATS, VATS, and open surgery for lobectomy. Using PubMed database, we selected systematic reviews and meta-analyses, which compared the short-term outcomes of patients treated by RATS, VATS, or open surgery for lobectomy. In all but one of the systematic reviews, robotic lobectomy allowed similar short-term outcomes as VATS lobectomy and better short-term outcomes than open surgery. One meta-analysis by O'Sullivan et al. found that robotic lobectomy was associated with fewer adverse events (P < 0.00001) and lower 30-day mortality (P = 0.001), compared to VATS lobectomy. Robotic lobectomy could be a valid alternative to VATS and open lobectomy. Shortterm outcomes do not appear to be different between VATS and RATS cohorts, except in one recent meta-analysis, which reported the superiority of RATS compared to VATS. Without cost analysis and randomized controlled trials with long-term outcomes, no strong conclusions can be drawn.

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

Montagne¹,

Bottet²,

Sarsam³

et al. 2020

MIS

View full text Add to dashboard Cite

show abstract

“…The proportion of lobectomies after introduction of this system performed by thoracotomy continued to decline. One study showed that, in 2008, 76.2% of lobectomies were performed using the open approach, compared with 23.4% and < 1.0% for VATS and robotic approaches, respectively [1] . In 2014, the majority of lobectomies was no longer performed via the open approach, and VATS and robotic approaches comprised 31.6% and 25.0% of lobectomies, respectively [1] .…”

Section: Introductionmentioning

confidence: 99%

“…One study showed that, in 2008, 76.2% of lobectomies were performed using the open approach, compared with 23.4% and < 1.0% for VATS and robotic approaches, respectively [1] . In 2014, the majority of lobectomies was no longer performed via the open approach, and VATS and robotic approaches comprised 31.6% and 25.0% of lobectomies, respectively [1] . Another study demonstrated that, from 2011 to 2015, lobectomies performed by thoracotomy had an absolute decline of 11.5% [2] .…”

Section: Introductionmentioning

confidence: 99%

Robotic lobectomy costs and quality of life

Nishimura¹,

Goodwin²,

Kneuertz³

et al. 2020

Mini-invasive Surg

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The surgical approach for lobectomy has changed over time with recent data demonstrating that the majority are performed using a minimally invasive approach. While the use of the robotic platform for pulmonary resection has been shown to have acceptable clinical outcomes, cost and quality of life need to be considered when starting a robotic lobectomy program. In this review, we evaluate the literature on cost of robotic lobectomy and quality of life. The results suggest that early experience in a robotic lobectomy program may be associated with relatively higher index hospital costs when compared to video-assisted thoracoscopic surgery; however, with increased experience and volume, the difference may no longer be of significance. When compared with thoracotomy, the cost is comparable if not less costly and may even be profitable for the hospital. Quality of life appears to be acceptable in the early experience of robotic lobectomy.

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