PURPOSE: Pulmonary lobectomy is performed by both thoracic surgeons and general surgeons. We sought to compare clinical outcomes of video-assisted thoracoscopic (VATS) lobectomy vs. open lobectomy using a national database.
METHODS: In 2007, a specific ICD-9 code became available for VATS lobectomy. The National Inpatient Sample (NIS), was used to identify patients with ICD-9 procedure codes of either VATS (32.41) or open (32.4) lobectomy. Of 29,829 lobectomies performed in 2007, 1731 (5.8%) were performed via VATS. Multivariate logistic regression analysis was used to compare morbidity and mortality between VATS and open lobectomy.
RESULTS: Individuals more likely to undergo a VATS lobectomy were younger than 40 (OR: 1.51, p<0.01), women (OR: 1.32, p<0.01), and of Asian ethnicity (OR: 1.54, p<0.01). Open lobectomies were more likely to occur in small (5.3% vs. 1.6%; p<0.01) and medium (17.7% vs. 13.1%) bed size hospitals in rural locations (5.8% vs. 2.2%; p<0.01). VATS lobectomy was more likely to be performed in large bed size hospitals (OR: 1.86, p<0.01), teaching hospitals (OR: 1.16, p<0.01), and urban hospitals (OR: 2.77, p<0.01). Overall morbidity was significantly increased in the open lobectomy group (18.5% vs. 13.3%, OR: 1.55(1.35-1.78); p<0.01). A greater proportion of patients undergoing open lobectomy experienced cardiac (5.3% vs. 3.2%; p<0.01) and respiratory (4.6% vs. 2.5%; p<0.01) complications, required transfusion for postoperative bleeding (11.0% vs. 7.9%; p<0.01) or required prolonged ventilation (3.3% vs. 2.0%; p<0.01) for > 96 hours. Accordingly, median postoperative length of stay was shorter among VATS patients (6 vs. 5 days; p<0.01).
CONCLUSION: VATS lobectomy is associated with decreased incidence of postoperative pulmonary and cardiac complications. Length of stay is shorter with VATS compared with open lobectomy. VATS is more likely to be performed in large, teaching hospitals in urban areas.
CLINICAL IMPLICATIONS: Based on the decreased morbidity and length of stay associated with VATS lobectomy, we expect that the incidence of VATS will continue to increase. This should parallel the adoption of minimally invasive techniques for cholecystectomy, appendectomy and colectomy.
DISCLOSURE: Elizabeth David, No Financial Disclosure Information; No Product/Research Disclosure Information