Original article
General thoracic
Open, Video-Assisted Thoracic Surgery, and Robotic Lobectomy: Review of a National Database

Presented at the Fifty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 7–10, 2012.
https://doi.org/10.1016/j.athoracsur.2013.07.117Get rights and content

Background

To date, reports on outcomes after robotic-assisted pulmonary resection have been confined to small, single-institution case series. Furthermore, no comparison has been made between robotic, open, and video-assisted thoracic surgery (VATS) procedures. We sought to compare the outcomes between these approaches using the State Inpatient Databases (SID).

Methods

Using the 2008 to 2010 SID, we identified patients who underwent an open, VATS, or robotic lobectomy from 8 states. Patients who underwent segmentectomy were also included. A comparison of outcomes was performed using a propensity-matched analysis.

Results

We identified a total of 33,095 patients (open: 20,238; VATS: 12,427; robotic: 430). Case volumes for robotic resections increased over the study period from 0.2% in 2008 to 3.4% in 2010. Robotic resections were performed in all 8 states, and 38% were conducted in a community hospital. In propensity-matched analysis, robotic resections were associated with significant reductions in mortality (0.2% vs 2.0%, p = 0.016), length of stay (5.9 vs 8.2 days, p < 0.0001), and overall complication rates (43.8% vs 54.1%, p = 0.003) when compared with open thoracotomy. Robotic resection was also associated with reductions in mortality (0.2% vs 1.1%, p = 0.12), length of stay (5.9 days vs 6.3 days, p = 0.45), and overall complication rates (43.8% vs 45.3%, p = 0.68) when compared with VATS; however, none of these differences were statistically significant.

Conclusions

Case volume for robotic pulmonary resections has increased significantly during the study period, and thoracic surgeons have been able to adopt the robotic approach safely. Robotic resection appears to be an appropriate alternative to VATS and is associated with improved outcomes compared with open thoracotomy.

Section snippets

Data Source

The SID are a family of datasets developed by the Healthcare Cost and Utilization Project (HCUP), and have been maintained by the Agency for Healthcare Research and Quality since 1995 [14]. The SID captures approximately 90% of all discharges within a given state, and contains a core set of clinical and nonclinical information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. More than 100 clinical and nonclinical

Trends in Use of VATS and Robotic Surgery

Over the 3-year period, 33,095 patients underwent a lobectomy or segmentectomy (Fig 1). Overall 430 cases (1.3%) were performed robotically. However, case volume for robotic resections increased over the study period, from 0.2% of cases in 2008 to 3.4% of cases in 2010. In addition, the proportion of cases performed through thoracotomy declined over the study period, from 66.3% in 2008 to 56.6% in 2010.

Hospital and Surgeon Characteristics

Pulmonary resections were performed in 711 hospitals in this dataset. A total of 37 centers

Comment

In this study the majority of cases were performed using an open approach, a finding consistent with prior publications using similar datasets 1, 20. Robotic pulmonary resections represented only 1.3% of all cases. However, robotic surgery was performed in all 8 states in the time period studied, and utilization increased significantly from 2008 (0.2% of all cases) to 2010 (3.4% of cases).

As shown in prior publications [21], VATS resections were associated with decreased mortality, rate of

References (24)

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Both authors contributed equally to this study.

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