Background: Video-assisted thoracic surgical (VATS) lobectomies and wedge resections result in less morbidity and shorter length of stay than resections via thoracotomy. The impact of robot-assisted thoracic surgical (RATS) lobectomy on clinical and economic outcomes has not been examined. This study compared hospital costs and clinical outcomes for VATS lobectomies and wedge resections versus RATS.Methods: Using the Premier hospital database, patients aged >= 18 years with a record of thoracoscopic lobectomy, segmental resection, or excision of a lesion or tissue from the lung between 2009 and 2011 were identified. Procedures using robotic technology were identified if 1 of 2 conditions were met: (1) a robotic International Classification of Diseases, Ninth Revision procedure code or (2) the text fields in the hospital record indicated that the robot was used. Using a propensity score and based on severity and comorbidities, certain demographics and hospital characteristics were matched. The association between VATS or RATS and adverse events, hospital costs, surgery time, and length of stay was examined.Results: Of 15,502 patient records analyzed, 96% (n = 14,837) were performed without robotic assistance. Using robotic assistance was associated with higher average hospital costs per patient. The average cost of inpatient procedures with RATS was $ 25,040.70 versus $ 20,476.60 for VATS (P =.0001) for lobectomies and $ 19,592.40 versus $ 16,600.10 (P -.0001) for wedge resections, respectively. Inpatient operating times were longer for RATS lobectomy than VATS lobectomy (4.49 hours vs 4.23 hours; P =.0959) and wedge resection (3.26 vs 2.86 hours; P =.0003). Length of stay was similar with no differences in adverse events.Conclusions: RATS lobectomy and wedge resection seem to have higher hospital costs and longer operating times, without any differences in adverse events.

Cost for single-port cholecystectomy in the outpatient setting was found to be greater than the cost for micro-laparoscopic or conventional laparoscopic cholecystectomy.

To compare clinical and economic outcomes for conventional laparoscopic (LAP) and robotic assisted minimally invasive surgery for segmental colectomies. Using the Premier hospital database patients >=18 years of age having one of the following primary LAP colectomies performed in 2009 to Q2 2011 were identified: cecectomy, hemi colectomy, left hemi colectomy, and sigmoidectomy. Those procedures utilizing robotic technology were identified if one of two conditions were met: 1) A robotic ICD-9 procedure code accompanied the primary procedure of interest, or 2) “text” fields in the hospital charge master file indicated use of the robot. Patients were matched on laparoscopic versus robotic colectomy using a propensity score on severity, certain demographic and hospital characteristics, and 1:1 on type of procedure. The association between robot-assisted colectomy and adverse events, hospital costs, surgery time, and length of stay was examined. Of 25,758 patient records from 364 hospitals, 98% (n=25,210) of laparoscopic colectomies were performed without robotic assistance; 2% (548) with robotic assistance. After matching, 1,066 patients remained, 533 in each group. No significant differences existed between the matched cohorts for major, minor and/or surgical complications. Use of the robot was associated with statistically higher mean per patient hospital costs. Inpatient procedures with and without robot assistance cost $17,445 vs. $15,447 (p=0.0008) respectively. The analysis did not include capital costs or service fees associated with maintaining the robot. Inpatient surgery times were significantly longer for robot-assisted procedures than non-robot procedures (4.37 vs. 3.34 hours; p <0.0001). Length of stay was similar. Findings reveal minimal clinical differences in peri and post-operative events and length of stay. There were significant increases in cost per case and OR time for robotic assisted versus conventional LAP procedures. These results call into question the cost-effectiveness of this technology in these procedures.

This study examined the effect of surgeons' volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS) on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures.

Video-Assisted Thoratic Surgical (VATS) lobectomies and wedge resections result in lower morbidity and shorter length of stay (LOS) than open thoracotomy. The impact of robotic-assisted VATS on clinical and economic outcomes, however, has not been examined. This study compared hospital costs and clinical outcomes for VATS lobectomies and wedge resections with and without robotic assistance. Using the Premier hospital database, patients aged >18 years with a record of thoracoscopic lobectomy (ICD-9 code 32.41), thoracoscopic segemental resection of lung (ICD-9 code 32.30), or thoracoscopic excision of lesion or tissue of lung (ICD-9 code 32.20) between 2009 to Q2 2011 were identified. Procedures utilizing robotic technology were identified if one of two conditions were met: (1) a robotic ICD-9 procedure code accompanied the procedure of interest or (2) “text” fields in the hospital charge master file indicated use of robot. Data were collected on intra-operative and post-operative complications, LOS, readmission rates, and total hospital cost for the procedures. Bivariate comparisons between VATS procedures with/without robotic assistance used Mann Whiteny-U to test for differences in median costs and surgery times. Of 15,502 patient records analyzed, 96% (n=14,837) were performed without robotic assistance. Using robotic assistance was associated with higher median per patient hospital costs (not including robotic capital or service contract). Median cost of inpatient procedures with/without robotic assistance was $22,331 versus $17,667 (p<0.0001) for lobectomies and $17,369 versus 13,574 (p<0.0001) for wedge resections respectively. Median inpatient surgery times were not significantly different for lobectomy (4.03 versus 4.00) but where longer for wedge resection. Surgery hours for robotic wedge resection versus non-robotic were 2.92 versus 2.25 (p<0.0001), respectively. Median LOS was similar across both groups. Based on this analysis, robotic-assisted VATS for lobectomy and wedge resection appears to have higher hospital costs and wedge resections have longer surgery times.

Background. The Premier Perspective Database (Premier Inc, Charlotte, NC) was used to compare hospital costs and perioperative outcomes for video-assisted thoracoscopic surgery (VATS) and open lobectomy procedures in the United States.Methods. Eligible patients underwent a lobectomy for cancer by a thoracic surgeon, by VATS or open thoracotomy and were captured in the database between third quarter of 2007 and through 2008. Multivariable logistic regression analyses were performed for binary outcomes. Ordinary least-squares regressions were used to estimate continuous outcomes. All models were adjusted for patient and hospital characteristics.Results. A total of 3,961 patients underwent a lobectomy by a thoracic surgeon by open (n = 2,907) or VATS (n = 1,054) approach. Hospital costs were higher for open versus VATS; $21,016 versus $20,316 (p = 0.027). Adjustment for surgeon experience with VATS over the 6 months prior to each operation showed a significant association between surgeon experience and cost. Average costs ranged from $22,050 for low volume surgeons to $18,133 for high volume surgeons. For open lobectomies, cost differences by surgeon experience were not significant and both levels were estimated at $21,000. Length of stay was 7.83 versus 6.15 days, for open versus VATS (p = 0.000). Surgery duration was shorter for open procedures at 3.75 versus 4.09 for VATS (p = 0.000). The risk of adverse events was significantly lower in the VATS group, odds ratio of 1.22 (p = 0.019).Conclusions. Lobectomy performed by the VATS approach as compared with an open technique results in shorter length of stay, fewer adverse events, and less cost to the hospital. Economic impact is magnified as the surgeon's experience increases. (Ann Thorac Surg 2012;93:1027-32) (C) 2012 by The Society of Thoracic Surgeons

OBJECTIVE The objective of this study was to compare the safety, use, and cost profiles of open thoracotomy vs video-assisted thoracoscopic surgery (VATS) for wedge resection in lung cancer performed by thoracic surgeons in the United States. METHODS The Premier database, which contains complete patient billing, hospital cost, and coding histories from > 25 million inpatient discharges and > 175 million hospital outpatient visits, was used for this analysis. Eligible patients were those who underwent wedge resection by a thoracic surgeon for cancer diagnosis or treatment through open thoracotomy or VATS in 2007 or 2008. Multivariable logistic regression analyses were run for binary outcomes, and ordinary least squares regressions were used for continuous outcomes. All models were adjusted for patient demographics, comorbid conditions, and hospital characteristics. RESULTS Of 8,228 eligible procedures, 2,051 patients underwent wedge resections by a thoracic surgeon using the open technique (n = 999) or VATS (n = 1,052). Hospital costs remained significantly higher for open wedge resections than for VATS ($17,377 vs $14,795, P = .000). Surgery time was significantly longer for open resections vs VATS (3.16 vs 2.82 h). Length of stay was 6.34 days for open vs 4.44 days for VATS. Adverse events were significant in the multivariable analysis, with an OR of 1.57 (95% CI, 1.29-1.91) in favor of VATS. CONCLUSIONS Although this retrospective database analysis could not address the issue of oncologic outcome equivalence, a clear advantage of VATS over open wedge lung cancer resection was found for both acute clinical outcomes and hospital costs.