New Research Shows Minimally Invasive, Video-Assisted Thoracoscopic Lobectomies For Lung Cancer More Cost Effective And Clinically Beneficial Than Traditional, Open Surgery
In a retrospective analysis using the Premier hospital database, the minimally-invasive approach of video-assisted thoracoscopic surgery (VATS) lobectomies for lung cancer indications show both clinical and economic advantages compared to open thoracotomy for lobectomy. Patients undergoing VATS lobectomy had significantly shorter lengths of stay and lower hospital costs than those undergoing the same procedure using an open approach for lung cancer indications. These advantages persisted even after adjusting for potentially important differences in patient and hospital characteristics. The study was accepted for publication in the Annals of Thoracic Surgery, and is currently published in the online edition. The study was funded by Ethicon Endo-Surgery, Inc.
(EES), a leading provider of advanced surgical solutions for minimally-invasive and open procedures.
"Although thoracic surgeons have several choices in the approach to diagnose and treat lung cancer, our findings indicate that VATS techniques provide better patient outcomes compared with open surgery.
As a result of better outcomes for patients - less complications and shorter length of stay - the hospital cost is significantly less," said Dr. Scott Swanson, Division of Thoracic Surgery, Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston. "We believe this evidence will help increase the adoption of VATS procedures for lung cancer indications." The study, entitled "Video-Assisted Thoracoscopic Lobectomy Is Less Costly and Morbid Than Open Lobectomy: A Retrospective Multi-Institutional Database Analysis*," was authored by Scott J.
Swanson, MD(i); Bryan F. Meyers, MD(ii); Candace L. Gunnarsson, EdD(iii); Matthew Moore, MHA, Ethicon Endo-Surgery, Inc.(iv); John A.
Howington, MD(v); Michael A. Maddaus, MD(vi); Robert J. McKenna, MD(vii); and Daniel L. Miller, MD(viii). The investigators assessed and compared the safety, utilization and cost profiles of VATS versus open thoracotomy for lobectomy in lung cancer among thoracic surgeons.
The study utilized the Premier hospital database as the data source; it contains clinical and utilization information on patients receiving care in more than 600 U.S. hospitals across the nation. The data also revealed that VATS lobectomies for lung cancer indications are performed in approximately half of all hospitals and one quarter of all patients undergoing lobectomy for lung cancer.
Of 8,228 patients in the database with elective, inpatient lung resections of any kind for lung cancer, a total of 3,961 patients underwent lobectomy by a thoracic surgeon using open thoracotomy (n=2,907) or VATS (n=1,054).
Overall, hospital costs were significantly higher for open lobectomy than for VATS: $21,016 versus $20,316 (p=0.027). The same was true for length of stay: 7.83 days vs. 6.15 days (p<0.006), for open versus VATS. The risk of patients needing prolonged hospital stays (> or = 14 days) also was significantly greater in the open lobectomy group than in the VATS lobectomy group. Conversely, surgery time remained significantly shorter for open lobectomy at 3.75 hours vs. 4.09 hours for VATS lobectomy (p=0.00).
"EES is committed to educating patients and providers about the clinical and economic benefits of minimally invasive surgery, including VATS lobectomy for lung cancer indications," said Matt Moore, director of Reimbursement and Healthcare Economics at EES.
About the Study The study protocol was submitted to and exempted by the New England Institutional Review Board (NEIRB) and exemption was obtained. The Premier hospital database used to collect data contains complete patient billing, hospital cost, and coding histories from more than 25 million inpatient discharges and 175 million hospital outpatient visits. Since VATS is such a new technology, the analyzable dataset was restricted to procedures occurring in 2007-2008. Only data that were anonymized with regard to patient identifiers were used.
Eligible patients were those of any age undergoing lobectomy by a thoracic surgeon for cancer treatment, via VATS methods or via open thoracotomy. Initial counts, percentages, means and standard deviations for patient demographics, comorbid conditions, hospital characteristics, and safety, utilization and cost outcomes were summarized for open lobectomy and VATS groups using descriptive statistics. The lobectomies studied were performed in 201 hospitals, with nearly all performing open lobectomies (n=194), and 57 percent performing VATS resections (n=114). The authors reported that VATS and open lobectomy patients are more likely to have surgery in larger hospitals, and in the case of VATS patients, more likely to be in teaching hospitals.
About Thoracic Surgery Historically, surgery involving the lung was accomplished in one of two ways, depending upon the clinical indication: via a thoracoscope (an instrument with a tiny video camera) inserted using a small incision, or via an open thoracotomy, involving a larger incision and rib-spreading to improve visibility and access for control of the surgical field. Thoracoscopic procedures were typically reserved for biopsies for diagnostic purposes, while open thoracotomies were performed for more extensive procedures such as wedge resection or lobectomy, often with therapeutic intent in severe emphysema or cancer.
Video-assisted thoracic surgery, or VATS, can be used to perform complex procedures, such as taking tissue samples for diagnosis as well as removing sections or even the entire diseased lung. For patients with clinical stage 1 non-small cell lung cancer, some studies have shown VATS: -- Is associated with a 70% less risk for complications after surgery and 61% less chance of pulmonary (lung-related) complications when compared to "open" procedures (which require a large incision).(1) -- May reduce recurring pain along with the need to treat chronic pain for longer than a year when compared to "open" procedures (which require a large incision).(1) -- May require significantly less painkiller medication and for a shorter time period when compared with those undergoing "open" procedures (which require a large incision).(1) There are additional benefits that may be especially important for cancer patients. Depending on the type of surgery performed, VATS patients may be able to receive a more effective dose of chemotherapy after surgery.(2) In addition, both approaches appear to be equally effective, with 5-year survival rates for VATS patients having been shown to be the same as patients who undergo "open" surgery (which requires a large incision).(1) While many surgeons recommend VATS for lobectomies in lung cancer patients, there are some risks. As with any procedure, there may be complications associated and it is important for patients to discuss all of the risks and benefits of minimally invasive lung resection surgery with their surgeons.
About Ethicon Endo-Surgery Ethicon Endo-Surgery is the world's leader in providing advanced medical devices for minimally invasive and open surgical procedures, focusing on procedure-enabling devices for the interventional diagnosis and treatment of conditions in general and bariatric surgery, as well as gastrointestinal health, gynecology and surgical oncology.More information can be found at www.ethiconendosurgery.com.
This study was sponsored by Ethicon Endo-Surgery.
*DSL# 12-0337 i. Sjswanson@partners.org, Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston, MA ii. Meyersb@wustl.edu, Washington University in St. Louis, St.
Louis, MO iii. Candaceg@s2stats.com, S2 11 Statistical Solutions, Inc.
Cincinnati, OH iv. MMoore2@its.jnj.com, Ethicon Endo-Surgery, Inc., Cincinnati, OH v. JHowington@northshore.org, NorthShore University Health System, Evanston, IL vi. Madda001@umn.edu, University of Minnesota, Duluth, MN vii. Cedars-Sinai Medical Center, Los Angeles, CA viii. Daniel.email@example.com,The Emory Clinic, Atlanta, GA References i. Downey RJ, Cheng D, Kernstine K, et al. Video-assisted thoracic surgery for lung cancer resection: a consensus statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2007. Innovations (Phila). 2007 Nov;2(6): 293-302.
ii. Petersen R, Pham D, Burfeind W, et al. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg. 2007 Apr;83(4):1245-9; discussion 1250.
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