Short-Term Readmissions After Open, Thoracoscopic, and Robotic Lobectomy for Lung Cancer Based on the Nationwide Readmissions Database
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Readmission after surgery is an established surrogate indicator of quality of care. We aimed to compare short-term readmission rates and patient outcomes between open, video-assisted thoracoscopic (VATS), and robotic lobectomies in the Nationwide Readmissions Database (NRD).
Adults who underwent open, VATS, or robotic lobectomy for lung cancer from 2010 to 2014 were evaluated. Propensity-matched analysis was used to assess differences in readmission characteristics, GDP-adjusted cost, and mortality.
Of the 129,539 lobectomies for lung cancer, 74,493 (57.5%) were open, 48,185 (37.2%) VATS, and 6861 (5.3%) robotic. Open surgery was associated with significantly higher readmission rate (10.5 vs 9.3%, p < 0.001), mortality (2 vs 1.2%, p < 0.001), index hospitalization cost [$21,846 (16,158–31,034) vs $20,779 (15,619–27,920), p < 0.001], and length of stay [6 (5–9) vs 4 (3–7) days, p < 0.001] compared to minimally invasive surgery. The robotic approach had similar mortality, readmission rate, and length of stay compared to VATS, but higher index cost [$23,870 (18,372–31,300) vs $20,279 (15,275–27,375), p < 0.001] and incidence of pulmonary complication (35.9 vs 31.6%, p < 0.001). The robotic approach was associated with greater direct discharges to home.
Analysis of the NRD revealed significantly reduced readmission rates, better clinical outcomes, and lower cost in the minimally invasive approach compared to open surgery. Although VATS and robotic surgery had similar readmission and mortality rates, VATS is associated with significantly reduced risk of short-term complications and lower cost.
J.Y. and K.L.B. were responsible for study concept and design. K.L.B. was responsible for acquisition and interpretation of data with the support of N.M., Y.J.S., D.E., and P.B. K.L.B. drafted the initial manuscript with critical revision by P.B. and J.Y. All authors have given final approval and agreed to be accountable for all aspects of the work. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
KLB took part in study design, data collection, data analysis, data interpretation, article drafting, and critical revision; NM performed article drafting; YJS was involved in data collection; DE carried out data analysis and critical revision; PB conducted study design, article drafting, and critical revision; and JY took part in study design, data analysis, data interpretation, and critical revision.
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Conflict of interest
The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this manuscript.
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