Elsevier

Thoracic Surgery Clinics

Volume 18, Issue 3, August 2008, Pages 297-300
Thoracic Surgery Clinics

Cost Comparison of Robotic, Video-assisted Thoracic Surgery and Thoracotomy Approaches to Pulmonary Lobectomy

https://doi.org/10.1016/j.thorsurg.2008.05.003Get rights and content

The financial impact of employing minimally invasive techniques for lobectomy compared with traditional open thoracotomy was assessed. A retrospective review was conducted using ICD9 codes for thoracotomy, video-assisted thoracic surgery (VATS), and robotic VATS lobectomy to determine total average costs associated with the resultant hospital stay. The difference in total average costs was calculated for each group. Robotic VATS lobectomy had higher associated costs than VATS only, primarily attributed to increased costs of the first hospital day, but was still less costly than thoracotomy. The average cost of VATS is substantially less than thoracotomy primarily because of a decreased length of stay. The cost of robotic assistance for VATS is still less than thoracotomy, but greater than VATS alone.

Section snippets

Materials and methods

Approval for the study was obtained and the need for individual patient consent was waived by the Institutional Review Board. The financial database (Decision Support System, Eclipsys Corporation, Atlanta, GA) of a single institution was queried retrospectively using CPT codes to identify all patients undergoing thoracotomy lobectomy (32480), VATS lobectomy (32663), and robotic VATS lobectomy (32663+99997) in the calendar year of 2007.

The type of surgical resection was determined by the

Results

From January 1, 2007, through December 31, 2007, 269 patients underwent thoracotomy lobectomy, and 99 patients underwent VATS lobectomy with 87 having VATS alone and 12 patients having a robotic-assisted procedure. The operating room times for each group were similar (thoracotomy: 3 hours, 43 minutes; VATS: 3 hours, 45 minutes; robotic: 3 hours, 37 minutes). The average length of stay of the thoracotomy group was 6 days versus 4 days for all VATS patients with no differences between length of

Comment

In this largest series of cases of lobectomy, by either thoracotomy or VATS (both robotic and nonrobotic), subjected to a cost analysis, we have shown that use of a minimally invasive VATS approach results in decreased cost of pulmonary lobectomy compared with standard thoracotomy. Taking into consideration real cost data that included all indirect, direct, and surgeon's fees, we demonstrated that patients undergoing thoracotomy incurred costs that were much higher than those undergoing VATS by

Acknowledgment

The authors acknowledge and thank Nicole M. Barrow, Donna Boccamazzo, and Suzanne Kelson from Memorial Sloan-Kettering Cancer Center's Clinical Systems and Hospital Administration who provided the financial data and analysis. We also thank Derek Goldstein and Intuitive Surgical for their input and support.

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