title: The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies.
abstract: OBJECTIVE
  Video-assisted thoracoscopic surgery (VATS) lobectomy is quickly becoming the standard of care for many patients with early-stage non-small-cell lung cancer (NSCLC) and benign lung conditions. There is a lack of published data defining the differential impact of preoperative patient comorbidity on outcomes following VATS and OPEN lobectomies, which would be beneficial for procedure selection and clinical decision-making.
  
  
  METHODS
  A retrospective analysis of the 2008-2011 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP) database was performed. Demographic and clinical data on patients ≥18 years having undergone VATS or OPEN lobectomy were included. Measured outcomes included postoperative length of stay (PO-LOS), in-hospital mortality and perioperative pulmonary complications. PO-LOS was further analysed using multivariable logistic regression and cumulative incidence models.
  
  
  RESULTS
  VATS lobectomies were associated with shorter PO-LOS and fewer complications even after censoring for inpatient mortality. Furthermore, VATS lobectomy patients had improved PO-LOS compared with OPEN lobectomy patients, even with greater comorbidity. Logistic regression modelling for PO-LOS ≥14 days identified independent predictors of prolonged PO-LOS, including male gender, non-elective admission, lower hospital lobectomy volume, several Elixhauser comorbidities and performance of OPEN lobectomy.
  
  
  CONCLUSIONS
  The expected postoperative length of stay for a patient treated by OPEN lobectomy is approximately equal to that of a VATS lobectomy patient with an additional 2-3 comorbidities. The VATS approach remains advantageous with respect to PO-LOS, regardless of the number of comorbidities.
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Oliver K
authors.initials: OK
authors.lastname: Jawitz
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Zuoheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Blasberg
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA anthony.kim@yale.edu.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008171:Lung Diseases / Q000453:epidemiology / Q000601:surgery; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Lobectomy; Thoracoscopic; VATS