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Original Research |

Hospital volume and outcomes of robot-assisted lobectomies

Lise N. Tchouta, MS; Henry S. Park, MD, MPH; Daniel J. Boffa, MD; Justin D. Blasberg, MD; Frank C. Detterbeck, MD; Anthony W. Kim, MD
Author and Funding Information

Source of Funding: LNT is the recipient of the Richard K. Gershon, M.D. research fellowship.

Conflict of Interest: The authors declare that there is no conflict of interest that would prejudice the impartiality of this document.

1Yale School of Medicine, Department of Surgery, Section of Thoracic Surgery

2Yale School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut, USA

Corresponding author Anthony W. Kim M.D. Yale School of Medicine Section of Thoracic Surgery 330 Cedar St, BB 205 New Haven, CT, 06520.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.09.008
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Abstract

Background  The positive impact of hospital operative volume on outcomes following video-assisted thoracoscopic surgery has been established. The goal of this study was to determine whether or not this volume-outcome relationship translates to robotic-assisted thoracoscopic surgery (RobATS) lobectomy.

Methods  Patients who underwent RobATS lobectomy were identified between 2008 and 2013 in the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) database. Hospital volume, as well as demographic, clinical, and healthcare system-related factors were selected as potential predictors of outcomes. Outcome variables included length of stay (LOS), in-patient mortality, and complications. Hospitals were designated by quartiles according to annual case volume with very low-volume defined as the 1st quartile and high-volume defined as the 4th quartile. Regression analyses were used to identify independent predictors of the outcomes of interest.

Results  A total of 8253 RobATS lobectomies were identified. Compared with very low-volume centers, patients at high-volume hospitals had a shorter mean LOS (5.8 vs 6.5 days, p=0.001) and decreased mortality rate (0.5% vs 1.9%, p<0.001), but more complications (28.1% vs 27.6%, p=0.025). In multivariable analysis, high hospital volume was prognostic for decreased mortality (OR=0.134, p<0.001) and shorter LOS (0.2 days; SE=0.05, p<0.001). Hospital volume was not prognostic for any complications including pulmonary, cardiovascular, intraoperative, or infectious complications.

Conclusions  Undergoing lobectomy at high-volume RobATS centers confers favorable mortality and LOS outcomes compared with very low-volume centers. In this relatively early phase of adoption of RobATS, the long-term clinical impact of differences in LOS as well as the lack of clinical impact on the incidence of complications remain to be determined more definitively. However, the beneficial effect of volume on mortality suggests a need for the careful adoption of this promising technology.


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