Comparison of outcome and cost in open and thoracoscopic pneumonectomy: A 13 years multicentre study

Abstract

Objective: We wanted to compare the outcome and cost of open and thoracoscopic (VATS) pneumonectomy. Introduction: The primary objective of this study was to compare the in-hospital mortality and morbidity of patients who underwent pneumonectomy either by thoracoscopy or thoracotomy approaches. We also wanted to determine risk factors for in-hospital mortality (death during hospital admission) and/or morbidity after pneumonectomy. Methodology: The Healthcare Cost and Utilization Project (HCUP), sponsored by The Agency for Healthcare Research and Quality’s (AHRQ), includes the largest collection of longitudinal hospital care data in the United States. The data in the HCUP databases primarily include data from non-federal community hospitals. HCUP creates the National In-patient Sample (NIS) to help conduct national and regional analysis of in-patient care. NIS was the primary database used for this research purpose. The NIS is derived from the State In-patient Databases (SID) and approximates a 20% sample of discharges from all HCUP community hospitals in the U.S. The NIS is the largest publicly available all-payer inpatient health care database in the United States, yielding national estimates of hospital inpatient stays. Unweighted, it contains data from more than 7 million hospital stays each year. Weighted, it estimates more than 35 million hospitalizations nationally. Results: We enrolled a total of 37,037 patients. Since 2001, the number of pneumonectomies have decreased from 3,518 to 1920 in 2013.The in-hospital mortality was 8.67 % in 2001 which is down to 4.43% in 2013. Mean charge increased from 48,412 $ in 2001 to 121069 $ in 2013. Also, there is no change in routine discharges, use of nursing home, rehabilitation institutions, home health care over the years 2008 to 2012. Mean length of hospital stay was 9.2 days. Total deaths in our study were 2959 patients. Conclusions: Thoracoscopic pneumonectomies decrease cost and are discharged to home more frequently as compared to open pneumonectomies. Abbreviations: AHRQ: The Agency for Healthcare Research and Quality’s; HCUP: The Healthcare Cost and Utilization Project; SID: State Inpatient Databases; NIS: National Inpatient Sample (NIS); ICD9-CM: International Classification of Diseases, Clinical Modification (ICD-9-CM); VATS: Video associated thoracoscopic surgery.