Hospital Volume and Outcomes of Robot-Assisted Lobectomies.
BACKGROUND
The positive impact of hospital operative volume on outcomes following video-assisted thoracoscopic surgery has been established. The goal of this study was to determine whether or not this volume/outcome relationship translates to robot-assisted thoracoscopic surgery (RobATS) lobectomy.


METHODS
Patients who underwent RobATS lobectomy were identified between 2008 and 2013 in the Healthcare Cost and Utilization Project National Inpatient Sample database. Hospital volume, as well as demographic, clinical, and health-care system-related factors were selected as potential predictors of outcomes. Outcome variables included length of stay (LOS), inpatient mortality, and complications. Hospitals were designated by quartiles according to annual case volume, with very low-volume defined as the first quartile and high-volume defined as the fourth quartile. Regression analyses were used to identify independent predictors of the outcomes of interest.


RESULTS
A total of 8,253 RobATS lobectomies were identified. Compared with very low-volume centers, patients at high-volume hospitals had a shorter mean LOS (5.8 vs 6.5 days; P = .001) and decreased mortality rate (0.5% vs 1.9%; P < .001) but more complications (28.1% vs 27.6%; P = .025). In multivariable analysis, high hospital volume was prognostic for decreased mortality (OR, 0.134; P< .001) and shorter LOS (0.2 days; SE, 0.05; P<.001). Hospital volume was not prognostic for any complications, including pulmonary, cardiovascular, intraoperative, or infectious complications.


CONCLUSIONS
Undergoing lobectomy at high-volume RobATS centers confers favorable mortality and LOS outcomes compared with very low-volume centers. In this relatively early phase of adoption of RobATS, the long-term clinical impact of differences in LOS as well as the lack of clinical impact on the incidence of complications remain to be determined more definitively. However, the beneficial effect of volume on mortality suggests a need for the careful adoption of this promising technology.
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Lise N
LN
Tchouta
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.
Henry S
HS
Park
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Daniel J
DJ
Boffa
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Justin D
JD
Blasberg
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Frank C
FC
Detterbeck
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. Electronic address: anthony.kim@yale.edu.
Anthony W
AW
Kim
D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000601:surgery; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
complications; lobectomy; lung cancer; outcomes; robotic thoracic surgery; volume