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Short-Term Readmissions After Open, Thoracoscopic, and Robotic Lobectomy for Lung Cancer Based on the Nationwide Readmissions Database

  • Katherine L. Bailey
  • Natalie Merchant
  • Young-Ji Seo
  • David Elashoff
  • Peyman Benharash
  • Jane YanagawaEmail author
Original Scientific Report
  • 30 Downloads

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

Notes

Acknowledgements

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.

Author's contribution

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.

Compliance with ethical standards

Conflict of interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this manuscript.

References

  1. 1.
    Dickinson KJ, Taswell JB, Allen MS et al (2017) Unplanned readmission after lung resection: complete follow-up in a 1-year cohort with identification of associated risk factors. Ann Thorac Surg 103(4):1084–1091CrossRefGoogle Scholar
  2. 2.
    Hu Y, Mcmurry TL, Isbell JM et al (2014) Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality. J Thorac Cardiovasc Surg 148(5):2261–2267CrossRefGoogle Scholar
  3. 3.
    Centers for Medicare and Medicaid Services (2018) Readmissions reduction program (HRRP). CMS.gov. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html. Accessed October 16, 2018
  4. 4.
    Stiles BM, Poon A, Giambrone GP et al (2016) Incidence and factors associated with hospital readmission after pulmonary lobectomy. Ann Thorac Surg 101(2):434–442CrossRefGoogle Scholar
  5. 5.
    Freeman RK, Dilts JR, Ascioti AJ et al (2013) A comparison of length of stay, readmission rate, and facility reimbursement after lobectomy of the lung. Ann Thorac Surg 96(5):1740–1745 (discussion 1745-6) CrossRefGoogle Scholar
  6. 6.
    Patient Protection and Affordable Care Act, Pub. L. No. 111-148, x2702, 124 Stat. 2010;119:318–9Google Scholar
  7. 7.
    Paul S, Altorki NK, Sheng S et al (2010) Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 139:366–378CrossRefGoogle Scholar
  8. 8.
    Tsai TC, Joynt KE, Orav EJ et al (2013) Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 369:1134–1142CrossRefGoogle Scholar
  9. 9.
    Detterbeck FC, Boffa DJ, Tanoue LT (2009) The new lung cancer staging system. Chest 136(1):260–271CrossRefGoogle Scholar
  10. 10.
    Park BJ, Yang HX, Woo KM et al (2016) Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer. J Thorac Dis 8(Suppl 4):S406–S413.  https://doi.org/10.21037/jtd.2016.04.56 CrossRefGoogle Scholar
  11. 11.
    Rajaram R, Mohanty S, Bentrem DJ et al (2017) Nationwide assessment of robotic lobectomy for non-small cell lung cancer. Ann Thorac Surg 103(4):1092–1100CrossRefGoogle Scholar
  12. 12.
    Swanson SJ, Miller DL, McKenna RJ et al (2014) Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database (Premier). J Thorac Cardiovasc Surg 147(3):929–937CrossRefGoogle Scholar
  13. 13.
    Kwon ST, Zhao L, Reddy RM et al (2017) Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection. J Thorac Cardiovasc Surg 154:652–659CrossRefGoogle Scholar
  14. 14.
    McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 81:421–425 (discussion 425-6) CrossRefGoogle Scholar
  15. 15.
    Assi R, Wong DJ, Boffa DJ et al (2015) Hospital readmission after pulmonary lobectomy is not affected by surgical approach. Ann Thorac Surg 99(2):393–398CrossRefGoogle Scholar
  16. 16.
    HCUP Nationwide Readmissions Database (NRD). Healthcare Cost and Utilization Project (HCUP). 2010–2014. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp
  17. 17.
    Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27CrossRefGoogle Scholar
  18. 18.
    Lucas DJ, Haider A, Haut E et al (2013) Assessing readmission after general, vascular, and thoracic surgery using ACS-NSQIP. Ann Surg 258(3):430–439CrossRefGoogle Scholar
  19. 19.
    Handy JR, Child AI, Grunkemeier GL et al (2001) Hospital readmission after pulmonary resection: prevalence, patterns, and predisposing characteristics. Ann Thorac Surg 72(6):1855–1860CrossRefGoogle Scholar
  20. 20.
    Jean RA, Chiu AS, Hoag JR, et al (2018) Identifying drivers of multiple readmissions following pulmonary lobectomy. Ann Thorac Surg. https://linkinghub.elsevier.com/retrieve/pii/S0003497518314802
  21. 21.
    Baltayiannis N, Chandrinos M, Anagnostopoulos D et al (2013) Lung cancer surgery: an up to date. J Thorac Dis 5(Suppl 4):S425–S439Google Scholar
  22. 22.
    Benzo R, Wigle D, Novotny P et al (2011) Preoperative pulmonary rehabilitation before lung cancer resection results from two randomized studies. Lung Cancer 74:441–445CrossRefGoogle Scholar
  23. 23.
    Ozyurtkan MO, Kaba E, Toker A (2017) What happens while learning robotic lobectomy for lung cancer? J Vis Surg 3(1):27CrossRefGoogle Scholar
  24. 24.
    Housmanou D, Khaled C, Till M (2018) Effectiveness of robotic lobectomy—outcome and learning curve in a high volume center. Thorac Cardiovasc Surg.  https://doi.org/10.1055/s-0038-1639477

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  2. 2.Department of Medicine Statistics CoreUniversity of California at Los AngelesLos AngelesUSA
  3. 3.Division of Cardiac SurgeryUniversity of CaliforniaLos AngelesUSA
  4. 4.UCLA Division of Thoracic SurgeryUniversity of CaliforniaLos AngelesUSA

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