title: Time is Money: Hospital Costs Associated With Video-Assisted Thoracoscopic Surgery Lobectomies.
abstract: BACKGROUND
  Proposed changes in health care will place an increasing burden on surgeons to care for patients more efficiently to minimize cost. We reviewed costs surrounding video-assisted thoracoscopic surgery (VATS) lobectomies to see where changes could be made to ensure maximum value.
  
  
  METHODS
  We queried The Society of Thoracic Surgeons database for all VATS lobectomies performed for lung cancer from January 2011 to December 2013. Clinical data were linked with hospital financial data to determine hospital expenditures for each patient.
  
  
  RESULTS
  In all, 263 VATS lobectomies were included. Mean operating room time was 236 minutes, and median length of stay was 4 days. Mean hospital cost was $19,769. The majority of cost (58%) was attributed to operating room and floor costs (length of stay), and the majority of operating room costs were secondary to room rate and staplers. A total of 77 complications, as defined by STS, occurred in the cohort; 41 patients had only one complication, 11 patients had two complications, and 6 patients had three or more complications. The occurrence of one complication was associated with a net loss of $496 whereas two complications in a patient led to a $3,882 net loss. Overall, complications were independently correlated with significant cost increases.
  
  
  CONCLUSIONS
  Our study shows that the most significant costs associated with VATS lobectomies relate to operating room time, stapler use, floor charges, and cost associated with complications. Cost-reducing strategies will need to concentrate on optimizing operating room times and reducing length of stay while simultaneously minimizing complications.
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Onkar V
authors.initials: OV
authors.lastname: Khullar
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
authors.affiliation: Department of Surgery Patient Safety and Data Management Program, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Perez
authors.affiliation: Department of Surgery Patient Safety and Data Management Program, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: William
authors.initials: W
authors.lastname: Knechtle
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Allan
authors.initials: A
authors.lastname: Pickens
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Manu S
authors.initials: MS
authors.lastname: Sancheti
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: sforce@emory.edu.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
mesh_terms: D000368:Aged; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D061646:Operative Time; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000191:economics*