Katherine L Bailey1, Natalie Merchant1, Young-Ji Seo1, David Elashoff2, Peyman Benharash1,3, Jane Yanagawa4,5. 1. David Geffen School of Medicine, University of California, Los Angeles, CA, USA. 2. Department of Medicine Statistics Core, University of California at Los Angeles, Los Angeles, CA, USA. 3. Division of Cardiac Surgery, University of California, Los Angeles, CA, USA. 4. David Geffen School of Medicine, University of California, Los Angeles, CA, USA. JYanagawa@mednet.ucla.edu. 5. UCLA Division of Thoracic Surgery, University of California, Box 957313, Rm 64-128 CHS, 10833 Le Conte Ave, Los Angeles, CA, 90095-7313, USA. JYanagawa@mednet.ucla.edu.
Abstract
BACKGROUND: Readmission after surgery is an established surrogate indicator of quality of care. We aimed to compare short-term readmission rates and patient outcomes between open, video-assisted thoracoscopic (VATS), and robotic lobectomies in the Nationwide Readmissions Database (NRD). METHODS: Adults who underwent open, VATS, or robotic lobectomy for lung cancer from 2010 to 2014 were evaluated. Propensity-matched analysis was used to assess differences in readmission characteristics, GDP-adjusted cost, and mortality. RESULTS: Of the 129,539 lobectomies for lung cancer, 74,493 (57.5%) were open, 48,185 (37.2%) VATS, and 6861 (5.3%) robotic. Open surgery was associated with significantly higher readmission rate (10.5 vs 9.3%, p < 0.001), mortality (2 vs 1.2%, p < 0.001), index hospitalization cost [$21,846 (16,158-31,034) vs $20,779 (15,619-27,920), p < 0.001], and length of stay [6 (5-9) vs 4 (3-7) days, p < 0.001] compared to minimally invasive surgery. The robotic approach had similar mortality, readmission rate, and length of stay compared to VATS, but higher index cost [$23,870 (18,372-31,300) vs $20,279 (15,275-27,375), p < 0.001] and incidence of pulmonary complication (35.9 vs 31.6%, p < 0.001). The robotic approach was associated with greater direct discharges to home. CONCLUSIONS: Analysis of the NRD revealed significantly reduced readmission rates, better clinical outcomes, and lower cost in the minimally invasive approach compared to open surgery. Although VATS and robotic surgery had similar readmission and mortality rates, VATS is associated with significantly reduced risk of short-term complications and lower cost.
BACKGROUND: Readmission after surgery is an established surrogate indicator of quality of care. We aimed to compare short-term readmission rates and patient outcomes between open, video-assisted thoracoscopic (VATS), and robotic lobectomies in the Nationwide Readmissions Database (NRD). METHODS: Adults who underwent open, VATS, or robotic lobectomy for lung cancer from 2010 to 2014 were evaluated. Propensity-matched analysis was used to assess differences in readmission characteristics, GDP-adjusted cost, and mortality. RESULTS: Of the 129,539 lobectomies for lung cancer, 74,493 (57.5%) were open, 48,185 (37.2%) VATS, and 6861 (5.3%) robotic. Open surgery was associated with significantly higher readmission rate (10.5 vs 9.3%, p < 0.001), mortality (2 vs 1.2%, p < 0.001), index hospitalization cost [$21,846 (16,158-31,034) vs $20,779 (15,619-27,920), p < 0.001], and length of stay [6 (5-9) vs 4 (3-7) days, p < 0.001] compared to minimally invasive surgery. The robotic approach had similar mortality, readmission rate, and length of stay compared to VATS, but higher index cost [$23,870 (18,372-31,300) vs $20,279 (15,275-27,375), p < 0.001] and incidence of pulmonary complication (35.9 vs 31.6%, p < 0.001). The robotic approach was associated with greater direct discharges to home. CONCLUSIONS: Analysis of the NRD revealed significantly reduced readmission rates, better clinical outcomes, and lower cost in the minimally invasive approach compared to open surgery. Although VATS and robotic surgery had similar readmission and mortality rates, VATS is associated with significantly reduced risk of short-term complications and lower cost.
Authors: Raees Tonse; Alexandra Townsend; Muni Rubens; Vitaly Siomin; Michael W McDermott; Martin C Tom; Matthew D Hall; Yazmin Odia; Manmeet S Ahluwalia; Minesh P Mehta; Rupesh Kotecha Journal: Sci Rep Date: 2021-11-12 Impact factor: 4.379