Analysis of Outcomes for Robotic-assisted Lobectomy With an Enhanced Recovery After Surgery Protocol

Background: The impact on cost relative to clinical efficacy of enhanced recovery after surgery (ERAS) protocols for patients who undergo robotic-assisted lobectomy is currently unknown. The objective of this study was to compare cost and perioperative outcomes of robotic-assisted lobectomy before and after implementation of an ERAS protocol.

Methods: This was a retrospective analysis of 574 patients who underwent robotic-assisted lobectomy for primary lung carcinoma from May 1, 2017 to June 1, 2021. The ERAS protocol was implemented on October 17, 2019. Inverse probability of treatment weighting of propensity scores was used to balance baseline characteristics. The primary outcomes of the study were mean direct and indirect hospital costs, complication rates, and hospital length of stay.

Results: Three hundred fifteen patients underwent robotic-assisted lobectomy before implementation of the ERAS protocol, and 259 patients were enrolled on the protocol. A significantly higher percentage of patients were discharged home in less than 3 days after the ERAS protocol implementation (24.5% vs 9.8%, P = .001). There were significant decreases in the inverse probability of treatment weighting-adjusted mean direct hospital costs (P < .001) and mean indirect costs (P = .018) for the total hospital stay after ERAS protocol implementation. The mean initial discharge opioid medication dose (morphine equivalent dose) was significantly lower (P < .001) after the ERAS protocol.

Conclusions: Increased early discharge and decreased hospital costs were observed for robotic-assisted lobectomy after implementation of an ERAS protocol. There was also an observed significant decrease in the discharge opioid medication doses prescribed.