title: Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy.
abstract: BACKGROUND
  Robotic-assisted lobectomy is being offered increasingly to patients. However, little is known about its safety, complication profile, or effectiveness.
  
  
  METHODS
  Patients undergoing lobectomy in in the United States from 2008 to 2011 were identified in the Nationwide Inpatient Sample. In-hospital mortality, complications, length of stay, and cost for patients undergoing robotic-assisted lobectomy were compared with those for patients undergoing thoracoscopic lobectomy.
  
  
  RESULTS
  We identified 2,498 robotic-assisted and 37,595 thoracoscopic lobectomies performed from 2008 to 2011. The unadjusted rate for any complication was higher for those undergoing robotic-assisted lobectomy than for those undergoing thoracoscopic lobectomy (50.1% vs 45.2%, P < .05). Specific complications that were higher included cardiovascular complications (23.3% vs 20.0%, P < .05) and iatrogenic bleeding complications (5.0% vs 2.0%, P < .05). The higher risk of iatrogenic bleeding complications persisted in multivariable analyses (adjusted OR, 2.64; 95% CI, 1.58-4.43). Robotic-assisted lobectomy costs significantly more than thoracoscopic lobectomy ($22,582 vs $17,874, P < .05).
  
  
  CONCLUSIONS
  In this early experience with robotic surgery, robotic-assisted lobectomy was associated with a higher rate of intraoperative injury and bleeding than was thoracoscopic lobectomy, at a significantly higher cost.
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. Electronic address: pas2022@med.cornell.edu.
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Public Health, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
authors.forename: Jessica
authors.initials: J
authors.lastname: Jalbert
authors.affiliation: Department of Public Health, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
authors.forename: Abby J
authors.initials: AJ
authors.lastname: Isaacs
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
authors.forename: O Wayne
authors.initials: OW
authors.lastname: Isom
authors.affiliation: Department of Public Health, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000191:economics* / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods* / Q000401:mortality; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014481:United States