Retrospective Data Analysis Suggests Clinical and Economic Advantages Of VATS vs Open Wedge Resection

“Any evidence supporting the advantages of VATS will further the adoption of these procedures, improving patient outcomes and lowering overall hospital costs.”

In short

According to a release issued by Ethicon Endo-Surgery, the results of a study suggesting that video-assisted thorascopic surgery (VATS) wedge resections are associated with significantly shorter operative times, shorter lengths of stay and lower hospital costs than open wedge resections for lung cancer indications.

Background

VATS wedge resections for lung cancer indications are now performed nearly as often as traditional and open wedge resections. This study took the form of a retrospective data analysis of key clinical parameters looking back at over 8000 patients.

In the study, entitled “In-hospital Clinical and Economic Consequences of Pulmonary Wedge Resections for Cancer Using Video-Assisted Thoracoscopic Techniques vs. Traditional Open Resections: A Retrospective Database Analysis,” investigators assessed the current use of VATS in wedge resections for lung cancer indications by comparing the safety, utilization and cost profiles of VATS versus open thoracotomy for wedge resection in lung cancer among thoracic surgeons. Data was sourced from more than 600 U.S. hospitals and ambulatory surgery centers.

Of the 8,228 eligible procedures in the database with inpatient lung resections for lung cancer, a total of 2,051 patients underwent wedge resections by a thoracic surgeon using open thoracotomy (n=999) or VATS (n=1,052).

Overall, hospital costs were significantly higher for open wedge resections than for VATS: $17,377 versus $14, 795 (p=0.000). In addition, surgery time was significantly longer for open resections at 3.16 hours versus 2.82 hours for VATS. The same was true for length of stay: 6.34 days vs. 4.44 days, for open versus VATS. Also, for several categories of adverse events, patients in the VATS group had significantly lower frequencies than patients undergoing open surgery.

The study was funded by Ethicon Endo-Surgery and has been published in the February issue of CHEST, the official publication of the American College of Chest Physicians.

Clinician comments 

“In the past two decades, thoracoscopic procedures for the diagnosis or treatment of lung cancer have been transformed by the ongoing refinement of VATS techniques and equipment, particularly high definition cameras and monitors. Thoracoscopic procedures are now rarely performed without the use of video-assistance, but the adoption has been slower in procedures that would be considered traditionally ‘thoracotomy settings,’ such as deep wedge resections, segmentectomy, and lobectomy,” said Dr. John Howington, Chief of Thoracic Surgery, NorthShore University HealthSystem, Evanston, Ill. “Any evidence supporting the advantages of VATS will further the adoption of these procedures, improving patient outcomes and lowering overall hospital costs.”

Company comments 

“Ethicon Endo-Surgery believes strongly in the potential for VATS techniques to transform patient care in wedge resections, and lung cancer in general. Any time you can increase quality while simultaneously decreasing costs, you are benefiting all the stakeholders which are rare, and in this era of healthcare reform, it is an extremely important consideration,” said Matt Moore, director of Reimbursement and Healthcare Economics at Ethicon Endo-Surgery.

We say

The press release from Ethicon Endo-Surgery seems to be quite supportive of VATS resection in the US healthcare system and while it is likely that the situation would be replicated in different markets, the treatment of cost elements would have to be compared in order to reach the same conclusion. Furthermore, the release does not speak to the matching of the populations, this being a retrospective data study. It would be interesting to know whether the reason patients underwent open vs VATS resection was due in any part to factors which may have skewed the results of this group, such as other complicating factors. Nonetheless an interesting study from a significant data set.

Source: Ethicon Endo-Surgery

CHEST Publication: “In-hospital Clinical and Economic Consequences of Pulmonary Wedge Resections for Cancer Using Video-Assisted Thoracoscopic Techniques vs. Traditional Open Resections: A Retrospective Database Analysis,” John A. Howington, Candace Gunnarsson, Michael A. Maddaus, Robert J. McKenna, Bryan F. Meyers, Daniel Miller, Matthew Moore, John A. Rizzo, and Scott Swanson.