Defining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches

doi:10.1016/j.athoracsur.2013.11.021

The Annals of Thoracic Surgery

Volume 97, Issue 3, March 2014, Pages 1000-1007

https://doi.org/10.1016/j.athoracsur.2013.11.021 Get rights and content

Background

Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures.

Methods

A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis.

Results

In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p < 0.001) owing to the cost of robotic-specific supplies and depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases.

Conclusions

VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs.

Section snippets

Material and Methods

A retrospective review of consecutive patients who had anatomic resection (lobectomy or segmentectomy) for clinical stage I or II NSCLC, carcinoid, or metastatic foci was performed from 2008 to 2012. We excluded patients who had chest wall invasion, induction therapy, positron emission tomography positive mediastinal nodes or central lesions. The Swedish Medical Center Institutional Review Board approved the study. Individual patient consent was waived for this study owing to its retrospective

Results

Overall, 190 consecutive patients were identified. Two cases for each modality were identified as outliers and were excluded, leaving 184 cases (69 open, 57 robotic, and 58 VATS) to be analyzed. The baseline patient and tumor characteristics are listed in Tables 1 and 2.

Robotic cases had the lowest length of stay but the highest operative time when comparing the groups. Operative time was statistically different among all three modalities, but length of stay was not (Table 3). A scatter plot

Comment

This study demonstrates that the overall cost of anatomic lung resection is similar when comparing open with VATS approaches and open with robotic approaches. While there were statistically significant differences in overall cost between robotic and VATS, these differences were accounted for by the capital depreciation of the robot and the robotic-specific supplies. When these variables were removed from the overall cost, the procedure specific costs were similar between the robotic group and

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Citation Excerpt :
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Original articleGeneral thoracicDefining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Original article
General thoracic
Defining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches