Trends of utilization and perioperative outcomes of robotic and video-assisted thoracoscopic surgery in patients with lung cancer undergoing minimally invasive resection in the United States

Yahya Alwatari; Jad Khoraki; Luke G Wolfe; Bhavishya Ramamoorthy; Natalie Wall; Christopher Liu; Walker Julliard; Carlos A Puig; Rachit D Shah

doi:10.1016/j.xjon.2022.07.014

Trends of utilization and perioperative outcomes of robotic and video-assisted thoracoscopic surgery in patients with lung cancer undergoing minimally invasive resection in the United States

JTCVS Open. 2022 Aug 18:12:385-398. doi: 10.1016/j.xjon.2022.07.014. eCollection 2022 Dec.

Authors

Yahya Alwatari¹, Jad Khoraki¹, Luke G Wolfe¹, Bhavishya Ramamoorthy¹, Natalie Wall¹, Christopher Liu¹, Walker Julliard¹, Carlos A Puig¹, Rachit D Shah¹

Affiliation

¹ Section of Thoracic and Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Va.

Abstract

Objective: The objective of this study was to evaluate utilization and perioperative outcomes of video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS) for lung cancer in the United States using a nationally representative database.

Methods: Hospital admissions for lobectomy or sublobar resection (segmentectomy or wedge resection) using VATS or RATS in patients with nonmetastatic lung cancer from October 2015 through December 2018 in the National Inpatient Sample were studied. Patient and hospital characteristics, perioperative complications and mortality, length of stay (LOS), and total hospital cost were compared. Logistic regression was used to assess whether the surgical approach was independently associated with adverse outcomes.

Results: There were 83,105 patients who had VATS (n = 65,375) or RATS (n = 17,710) for lobectomy (72.7% VATS) or sublobar resection (84.2% VATS). Utilization of RATS for lobectomy and sublobar resection increased from 19.2% to 34% and 7.3% to 22%, respectively. Mortality, LOS, and conversion rates were comparable. The cost was higher for RATS (P <.01). Multivariate analyses showed comparable RATS and VATS complications with no independent association between the minimally invasive surgery approach used and adverse surgical outcomes, except for a decreased risk of pneumonia with RATS, relative to VATS sublobar resection (P <.01). Thoracic complication rates and LOS decreased after RATS lobectomy in 2018, compared with previous years (P <.005).

Conclusions: The utilization of robotic-assisted lung resection for cancer has increased in the United States between 2015 and 2018 for sublobar resection and lobectomy. In adjusted regression analysis, compared with VATS, patients who underwent RATS had similar complication rates and LOS. The robotic approach was associated with increased total hospital cost. LOS and thoracic complication rates trended down after RATS lobectomy.

Keywords: HCUP, Healthcare Cost and Utilization Project; ICD-10, International Classification of Diseases, 10th Revision; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification; ICD-10-PCS, International Classification of Diseases, 10th Revision Procedure Coding System; LOS, length of stay; MIS, minimally invasive surgery; NIS, National Inpatient Sample; Q4, fourth quarter; RATS, robotic-assisted thoracoscopic surgery; VATS, video-assisted thoracoscopic surgery; lung cancer; robotic; video-assisted thoracoscopic surgery.