title: Decreased In-Hospital Mortality after Lobectomy Using Video-assisted Thoracoscopic Surgery Compared with Open Thoracotomy.
abstract: BACKGROUND
  There is a paucity of data regarding the optimal surgical approach for lung lobectomy. Lobectomy performed by video-assisted thoracoscopic surgery (VATS) has been associated with lower morbidity as compared with lobectomy performed by thoracotomy. However, no multicenter studies have shown improved mortality with VATS lobectomy compared with open surgical lobectomy.
  
  
  OBJECTIVE
  We used data from the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2009 to 2012 to compare VATS with open lobectomy for in-hospital mortality and other short-term outcomes.
  
  
  METHODS
  We used International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes to identify the patients undergoing lobectomy. We used 1:1 ratio propensity matching with the nearest neighbor method without replacement to generate matched pairs.
  
  
  RESULTS
  Over the 4-year period, 27,451 patients underwent lobectomy. The majority of these procedures were performed by thoracotomy (65%) as compared with VATS (35%). A total of 9,393 matched pairs were created. VATS lobectomy was associated with significantly lower in-hospital mortality when compared with thoracotomy (1.3% vs. 2.5%, P < 0.001). A shorter length of hospital stay was observed for those undergoing VATS lobectomy (6.21 vs. 8.75 d, P < 0.001). The overall rate of perioperative complications was low, with those undergoing VATS being less likely to have any perioperative morbidity.
  
  
  CONCLUSIONS
  In recent years, the use of VATS for lobectomy has increased relative to thoracotomy. This trend has coincided with increased survival and shorter length of stay for VATS lobectomy compared with thoracotomy. Further studies are needed to identify comorbidities that identify ideal candidates for VATS lobectomy.
authors: 1 Department of Medicine.
authors: Hem
authors: H
authors: Desai
authors: 1 Department of Medicine.|2 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and.
authors: Bhupinder
authors: http://orcid.org/0000-0002-3871-0513
authors: B
authors: Natt
authors: 3 Department of Cardiothoracic Surgery, University of Arizona Health Sciences, Tucson, Arizona.
authors: Samuel
authors: S
authors: Kim
authors: 1 Department of Medicine.|2 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and.
authors: Christian
authors: C
authors: Bime
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D063868:Patient Outcome Assessment; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data*; D013908:Thoracotomy / Q000706:statistics & numerical data*; D014481:United States
keywords: patient outcomes assessment; thoracotomy; video-assisted thoracic surgery