title: Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database (Premier).
abstract: BACKGROUND
  Video-assisted thoracic surgical (VATS) lobectomies and wedge resections result in less morbidity and shorter length of stay than resections via thoracotomy. The impact of robot-assisted thoracic surgical (RATS) lobectomy on clinical and economic outcomes has not been examined. This study compared hospital costs and clinical outcomes for VATS lobectomies and wedge resections versus RATS.
  
  
  METHODS
  Using the Premier hospital database, patients aged ≥18 years with a record of thoracoscopic lobectomy, segmental resection, or excision of a lesion or tissue from the lung between 2009 and 2011 were identified. Procedures using robotic technology were identified if 1 of 2 conditions were met: (1) a robotic International Classification of Diseases, Ninth Revision procedure code or (2) the text fields in the hospital record indicated that the robot was used. Using a propensity score and based on severity and comorbidities, certain demographics and hospital characteristics were matched. The association between VATS or RATS and adverse events, hospital costs, surgery time, and length of stay was examined.
  
  
  RESULTS
  Of 15,502 patient records analyzed, 96% (n = 14,837) were performed without robotic assistance. Using robotic assistance was associated with higher average hospital costs per patient. The average cost of inpatient procedures with RATS was $25,040.70 versus $20,476.60 for VATS (P = .0001) for lobectomies and $19,592.40 versus $16,600.10 (P = .0001) for wedge resections, respectively. Inpatient operating times were longer for RATS lobectomy than VATS lobectomy (4.49 hours vs 4.23 hours; P = .0959) and wedge resection (3.26 vs 2.86 hours; P = .0003). Length of stay was similar with no differences in adverse events.
  
  
  CONCLUSIONS
  RATS lobectomy and wedge resection seem to have higher hospital costs and longer operating times, without any differences in adverse events.
authors.affiliation: Division of Minimally Invasive Thoracic Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Swanson
authors.affiliation: Division of Thoracic Surgery, Emory University Healthcare, Atlanta, Ga.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Miller
authors.affiliation: Division of Thoracic Surgery, Cedars Sinai Medical Center, Los Angeles, Calif.
authors.forename: Robert Joseph
authors.initials: RJ
authors.lastname: McKenna
authors.affiliation: Division of Thoracic Surgery and Surgical Quality, NorthShore University Health System, Evanston, Ill.
authors.forename: John
authors.initials: J
authors.lastname: Howington
authors.affiliation: Division of Thoracic Surgery, Georgetown University Medical Center, Washington, DC.
authors.forename: M Blair
authors.initials: MB
authors.lastname: Marshall
authors.affiliation: Ethicon Endo-Surgery, Inc a Johnson & Johnson Company, Cincinnati, Ohio.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Yoo
authors.affiliation: Healthcare Policy and Economics, Ethicon Endo-Surgery, Cincinnati, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Moore
authors.affiliation: S(2) Statistical Solutions, Inc., Cincinnati, Ohio. Electronic address: candaceg@s2stats.com.
authors.forename: Candace L
authors.initials: CL
authors.lastname: Gunnarsson
authors.affiliation: Division of Cardiothoracic Surgery, Barnes-Jewish Hospital Plaza, Washington University in St. Louis, St. Louis, Mo.
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006801:Humans; D016018:Least-Squares Analysis; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy; D057216:Propensity Score; D012371:Robotics / Q000191:economics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000191:economics; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult