VATS Versus Robotic Anatomic Pulmonary Resection in a High-Volume Institution: Cost and Outcomes Analysis.

IF 1.6 Q2 SURGERY
Claire Perez, Lucas Weiser, Justin J Watson, Allen Razavi, Shruthi Nammalwar, Charles Fuller, Sevannah Soukiasian, Zishi Li, Raffaele Rocco, Andrew R Brownlee, Harmik J Soukiasian
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Abstract

Objective: This study evaluates the impact of transitioning from video-assisted thoracoscopic surgery (VATS) to robot-assisted thoracoscopic surgery (RATS) on patient outcomes and costs, based on the experience of a single surgeon at a quaternary center.

Methods: We reviewed patients who underwent anatomic lung resections by a single surgeon between 2015 and 2022, excluding nonanatomic resections and those involving robotic bronchoscopy followed by resection. We compared baseline characteristics, short-term outcomes, and costs between the VATS (2015 to 2018) and robotic (2018 to 2022) groups. Charges were adjusted to 2023 dollars for comparison across different time periods.

Results: A total of 210 patients (140 robotic, 70 VATS) were analyzed, with no significant differences in baseline characteristics. Robotic surgery had a longer median procedure time (161 vs 145 min, P < 0.002). Length of stay was similar (5.3 ± 6.3 days for robotic vs 6.54 ± 7.5 days for VATS, P = 0.23), as were 30-day readmission rates (5% for robotic vs 5.7% for VATS, P = 0.83). Major complications occurred in 5 robotic and 5 VATS cases (P = 0.528). Adjusted direct charges were $40,250.40 (95% confidence interval [CI]: $34,739.0 to $45,761.8) for robotic and $44,124.00 (95% CI: $35,036.0 to $53,211.9) for VATS (P = 0.47). Total hospital charges were $74,199.00 (95% CI: $64,398.9 to $83,999.2) for robotic and $80,549.00 (95% CI: $63,028.9 to $98,069.3) for VATS (P = 0.498).

Conclusions: Transitioning from VATS to RATS can be done safely without increasing costs or morbidity. In addition, the robotic approach demonstrated numerically lower charges, even during the surgeon's early learning curve. Hospital cost savings would be expected to increase as operative efficiency improves.

VATS与机器人解剖肺切除术在大容量机构:成本和结果分析。
目的:本研究评估从视频辅助胸腔镜手术(VATS)过渡到机器人辅助胸腔镜手术(RATS)对患者预后和成本的影响,基于一位四级中心外科医生的经验。方法:我们回顾了2015年至2022年间由单一外科医生进行解剖性肺切除术的患者,不包括非解剖性肺切除术和机器人支气管镜手术后切除的患者。我们比较了VATS组(2015年至2018年)和机器人组(2018年至2022年)的基线特征、短期结果和成本。费用调整为2023美元,以便在不同时期进行比较。结果:共分析了210例患者(140例机器人,70例VATS),基线特征无显著差异。机器人手术的中位手术时间更长(161分钟vs 145分钟,P < 0.002)。住院时间相似(机器人组为5.3±6.3天,VATS组为6.54±7.5天,P = 0.23), 30天再入院率相似(机器人组为5%,VATS组为5.7%,P = 0.83)。5例机器人和5例VATS出现主要并发症(P = 0.528)。调整后的机器人直接费用为40,250.40美元(95%置信区间[CI]: 34,739.0美元至45,761.8美元),VATS为44,124.00美元(95%置信区间:35,036.0美元至53,211.9美元)(P = 0.47)。机器人的医院总费用为74,199.00美元(95% CI: 64,398.9美元至83,999.2美元),VATS的医院总费用为80,549.00美元(95% CI: 63,028.9美元至98,069.3美元)(P = 0.498)。结论:从VATS过渡到RATS可以安全进行,不会增加成本或发病率。此外,即使在外科医生的早期学习曲线中,机器人方法也显示出较低的费用。随着手术效率的提高,预计医院成本节约将会增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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