Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients.
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) is becoming increasingly popular for lung resection in some centers. However, the issue of whether VATS or open thoracotomy is better remains controversial. We compared outcomes of open and VATS lobectomy in a national database.


METHODS
Using the 2004 and 2006 Nationwide Inpatient Sample database, we identified 13,619 discharge records of patients who underwent pulmonary lobectomy by means of thoracotomy (n = 12,860) or VATS (n = 759). Student's t and chi(2) tests were used to compare the two groups. Multivariable analysis was used to identify independent predictors of outcome measures.


RESULTS
The two groups of patients had similar demographics and preoperative comorbidities. They also had similar in-hospital mortality rates (3.1% versus 3.4%; p = 0.67); lengths of stay (9.3 +/- 0.1 versus 9.2 +/- 0.4 days; p = 0.84); hospitalization costs ($23,862 +/- $206 versus $25,125 +/- $1,093; p = 0.16); and rates of wound infection (0.8% versus 1.3%; p = 0.15), pulmonary complications (32.2% versus 31.2%; p = 0.55), and cardiovascular complications (3.4% versus 3.9%; p = 0.43). However, multivariable analysis showed that the VATS group had a significantly higher incidence of intraoperative complications than the thoracotomy group (odds ratio, 1.6; 95% confidence interval, 1.0 to 2.4; p = 0.04). A higher percentage of patients with annual income greater than $59,000 underwent VATS lobectomy than patients with income less than $59,000 (35.7% versus 25.4%; p < 0.0001).


CONCLUSIONS
Patients who underwent VATS lobectomy were 1.6 times more likely to have intraoperative complications than patients who underwent open lobectomy. However, short-term mortality, lengths of stay, and hospitalization costs were similar between the two groups of patients. There seems to be a socioeconomic disparity between VATS and open thoracotomy patients.
Gopaldas
Raja R
RR
The Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Texas, USA.
Bakaeen
Faisal G
FG
Dao
Tam K
TK
Walsh
Garrett L
GL
Swisher
Stephen G
SG
Chu
Danny
D
D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000191:economics / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011336:Probability; D018570:Risk Assessment; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics / Q000379:methods* / Q000401:mortality; D013908:Thoracotomy / Q000191:economics / Q000379:methods* / Q000401:mortality