Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches.
BACKGROUND
Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures.


METHODS
A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis.


RESULTS
In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p < 0.001) owing to the cost of robotic-specific supplies and depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases.


CONCLUSIONS
VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs.
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington. Electronic address: brian.louie@swedish.org.
Shaun A
SA
Deen
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Jennifer L
JL
Wilson
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Candice L
CL
Wilshire
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Eric
E
Vallières
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Alexander S
AS
Farivar
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Ralph W
RW
Aye
Clinical Transformation Department, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Robson E
RE
Ely
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Brian E
BE
Louie
D000368:Aged; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D061646:Operative Time; D011013:Pneumonectomy / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics*; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics*