PURPOSE: This research project used the Premier database to compare hospital costs and clinical outcomes for VATS versus open wedge resection procedures in the USA. The Premier hospital database houses data from over 600 U.S. hospitals and ambulatory surgery centers in all regions of the United States.
METHODS: Eligible patients were those of any age undergoing wedge resection by a thoracic surgeon for cancer diagnosis or treatment, via VATS method or via open thoracotomy in the Premier hospital database for the year 2008. Multivariable logistic regression analyses were run for binary outcomes, such as adverse events; and for continuous outcomes, such as hospital costs, surgery time, and length of stay ordinary least squares (OLS) regressions were used. All models were adjusted for patient demographics and comorbid conditions, as well as, hospital demographics.
RESULTS: Of 8,228 eligible procedures in the database, a total of 2,051 patients underwent wedge resections by a thoracic surgeon using the open technique (n=999) or VATS (n=1,052). Hospital costs remained significantly higher for open wedge resections than for VATS: $17,377 vs. $14, 795 (p=0.000). Surgery time was significantly longer for open resections at 3.16 hours vs. 2.82 hours for VATS. The same was true for length of stay: 6.34 days vs. 4.44 days, for Open vs. VATS. Furthermore, adverse events overall were significant in the multivariable analysis, with an odds ratio of 1.57 (95% CI = 1.29, 1.91) in favor of VATS.
CONCLUSION: VATS wedge resections when compared to open result in shorter length of stay and fewer adverse events for the patient as well as less cost to the hospital.
CLINICAL IMPLICATIONS: In this era of comparative effectiveness, hospitals and clinicians should consider greater utilization of VATS techniques for wedge resection, because it is beneficial from both a clinical outcomes and cost perspective.
DISCLOSURE: John Howington, Employee Matthew Moore is an employee of Ethicon Endo Surgery, Inc.; Consultant fee, speaker bureau, advisory committee, etc. Candace Gunnarsson, EdD is a paid consultant to Ethicon Endo Surgery, Inc.John Howington, MD is on the advisory panel of Ethicon Endo Surgery, inc.Robert McKenna, MD is on the advisory panel of Ethicon Endo Surgery, inc.Bryan Myers, MD is on the advisory panel of Ethicon Endo Surgery, inc.Daniel Miller, MD is on the advisory panel of Ethicon Endo Surgery, inc.Michael Maddaus, MD is on the advisory panel of Ethicon Endo Surgery, inc.; No Product/Research Disclosure Information