scholarly journals Comparison of cost effectiveness between video-assisted thoracoscopic surgery (vats) and open lobectomy: a retrospective study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wei Chen ◽  
Zhanwu Yu ◽  
Yichen Zhang ◽  
Hongxu Liu
Keyword(s):  
Economic Burden ◽  
Thoracoscopic Surgery ◽  
Clinical Effectiveness ◽  
Lung Infection ◽  
Vats Lobectomy ◽  
Factors Associated ◽  
Hospitalization Costs ◽  
Lower Lung ◽  
Open Lobectomy ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Lung cancer is highly prevalent in Chinese population. The association of operative approach with economic burden in these patients remains unknown. Objectives This institution-level cohort study aimed to compare the cost-related clinical outcomes and health care costs among patients undergoing video-assisted thoracoscopic surgery (VATS) and open lobectomy, and to investigate the factors associated with the costs. Methods This retrospective cohort study included patients who underwent VATS or open lobectomy in a provincial referral cancer center in China in 2018. Propensity score matching (PSM) method was applied to balance the baseline characteristics in VATS lobectomy and open lobectomy group. Clinical effectiveness measures included post-operative blood transfusion, lung infection, and length of stay (LOS). Hospitalization costs were extracted from hospital information system to assess economic burden. Multivariable generalized linear model (GLM) with gamma probability distribution and log-link was used to analyze the factors associated with total costs. Results After PSM, 376 patients were selected in the analytic sample. Compared to open lobectomy group, the VATS lobectomy group had a lower blood transfusion rate (2.13% vs. 3.19%, P = 0.75), lower lung infection rate (21.28% vs. 39.89%, P < 0.001) and shorter post-operative LOS (9.4 ± 3.22 days vs. 10.86 ± 4.69 days, P < 0.001). Total hospitalization costs of VATS lobectomy group and open lobectomy were similar: Renminbi (RMB) 84398.03 ± 13616.13, RMB 81,964.92 ± 16748.11, respectively (P = 0.12). Total non-surgery costs were significantly lower in the VATS lobectomy group than in the open lobectomy group: RMB 41948.40 ± 7747.54 vs. RMB 45752.36 ± 10346.42 (P < 0.001). VATS approach, lung infection, longer post-operative length of stay, health insurance coverage, and lung cancer diagnosis were associated with higher total hospitalization costs (P < 0.05). Conclusions VATS lobectomy has a lower lung infection rate, and shorter post-operative LOS than open lobectomy. Future studies are needed to investigate other aspects of clinical effectiveness and the economic burden from a societal perspective.

scholarly journals Comparison of Cost Effectiveness between Video-Assisted Thoracoscopic Surgery (VATS) and Open Lobectomy: A Retrospective Study

2020 ◽  
Author(s):  
Wei Chen ◽  
Zhanwu Yu ◽  
Yichen Zhang ◽  
Hongxu Liu
Keyword(s):  
Blood Transfusion ◽  
Economic Burden ◽  
Thoracoscopic Surgery ◽  
Clinical Effectiveness ◽  
Lung Infection ◽  
Transfusion Rate ◽  
Vats Lobectomy ◽  
Hospitalization Costs ◽  
Lower Lung ◽  
Open Lobectomy

Abstract Background Lung cancer is highly prevalent in Chinese population. The association of operative approach with economic burden in these patients remains unknown. ObjectivesThis institution-level cohort study aimed to compare the cost-related clinical outcomes and health care costs among patients undergoing video-assisted thoracoscopic surgery (VATS) and open lobectomy, and to investigate the factors associated with the costs. MethodsThis retrospective cohort study included patients who underwent VATS or open lobectomy in a provincial referral cancer center in China in 2018. Clinical effectiveness measures included post-operative blood transfusion, lung infection, and length of stay (LOS). Hospitalization costs were extracted from hospital information system to assess economic burden. ResultsCompared to open lobectomy group, the VATS lobectomy group had a lower blood transfusion rate (1.70% vs. 4.33%, P=0.033), lower lung infection rate (23.77% vs. 40.87%, P<0.001) and shorter post-operative LOS (9.42 ± 3.72 days vs. 10.97 ± 5.81 days, P<0.001). Total hospitalization costs of VATS lobectomy group and open lobectomy were similar: RMB 84,908.72±18,914.87, RMB 81,944.70 ±16,625.20, respectively. VATS approach, lung infection, longer post-operative length of stay, male sex, lung cancer diagnosis, and heart disease were associated with higher total hospitalization costs (P<0.05). ConclusionsVATS lobectomy has a lower post-operative blood transfusion rate, lower lung infection rate, and shorter post-operative LOS than open lobectomy. Future studies are needed to investigate other aspects of clinical effectiveness and the economic burden from a societal perspective.

scholarly journals The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

2017 ◽  
Vol 99 (2) ◽  
pp. 129-133 ◽  
Author(s):  
A Vallance ◽  
P Tcherveniakov ◽  
C Bogdan ◽  
N Chaudhuri ◽  
R Milton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Conversion Rate ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Single Centre ◽  
Vats Lobectomy ◽  
Video Assisted ◽  
Intraoperative Conversion ◽  
Video Assisted Thoracoscopic Surgery

INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010–2012: 277/713 [38.8%], 2013–2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.

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