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Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients.
Ann Thorac Surg. 2010 May; 89(5):1563-70.AT

Abstract

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) is becoming increasingly popular for lung resection in some centers. However, the issue of whether VATS or open thoracotomy is better remains controversial. We compared outcomes of open and VATS lobectomy in a national database.

METHODS

Using the 2004 and 2006 Nationwide Inpatient Sample database, we identified 13,619 discharge records of patients who underwent pulmonary lobectomy by means of thoracotomy (n = 12,860) or VATS (n = 759). Student's t and chi(2) tests were used to compare the two groups. Multivariable analysis was used to identify independent predictors of outcome measures.

RESULTS

The two groups of patients had similar demographics and preoperative comorbidities. They also had similar in-hospital mortality rates (3.1% versus 3.4%; p = 0.67); lengths of stay (9.3 +/- 0.1 versus 9.2 +/- 0.4 days; p = 0.84); hospitalization costs ($23,862 +/- $206 versus $25,125 +/- $1,093; p = 0.16); and rates of wound infection (0.8% versus 1.3%; p = 0.15), pulmonary complications (32.2% versus 31.2%; p = 0.55), and cardiovascular complications (3.4% versus 3.9%; p = 0.43). However, multivariable analysis showed that the VATS group had a significantly higher incidence of intraoperative complications than the thoracotomy group (odds ratio, 1.6; 95% confidence interval, 1.0 to 2.4; p = 0.04). A higher percentage of patients with annual income greater than $59,000 underwent VATS lobectomy than patients with income less than $59,000 (35.7% versus 25.4%; p < 0.0001).

CONCLUSIONS

Patients who underwent VATS lobectomy were 1.6 times more likely to have intraoperative complications than patients who underwent open lobectomy. However, short-term mortality, lengths of stay, and hospitalization costs were similar between the two groups of patients. There seems to be a socioeconomic disparity between VATS and open thoracotomy patients.

Authors+Show Affiliations

The Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20417778

Citation

Gopaldas, Raja R., et al. "Video-assisted Thoracoscopic Versus Open Thoracotomy Lobectomy in a Cohort of 13,619 Patients." The Annals of Thoracic Surgery, vol. 89, no. 5, 2010, pp. 1563-70.
Gopaldas RR, Bakaeen FG, Dao TK, et al. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. Ann Thorac Surg. 2010;89(5):1563-70.
Gopaldas, R. R., Bakaeen, F. G., Dao, T. K., Walsh, G. L., Swisher, S. G., & Chu, D. (2010). Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. The Annals of Thoracic Surgery, 89(5), 1563-70. https://doi.org/10.1016/j.athoracsur.2010.02.026
Gopaldas RR, et al. Video-assisted Thoracoscopic Versus Open Thoracotomy Lobectomy in a Cohort of 13,619 Patients. Ann Thorac Surg. 2010;89(5):1563-70. PubMed PMID: 20417778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. AU - Gopaldas,Raja R, AU - Bakaeen,Faisal G, AU - Dao,Tam K, AU - Walsh,Garrett L, AU - Swisher,Stephen G, AU - Chu,Danny, PY - 2009/11/04/received PY - 2010/02/08/revised PY - 2010/02/12/accepted PY - 2010/4/27/entrez PY - 2010/4/27/pubmed PY - 2010/6/4/medline SP - 1563 EP - 70 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 89 IS - 5 N2 - BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is becoming increasingly popular for lung resection in some centers. However, the issue of whether VATS or open thoracotomy is better remains controversial. We compared outcomes of open and VATS lobectomy in a national database. METHODS: Using the 2004 and 2006 Nationwide Inpatient Sample database, we identified 13,619 discharge records of patients who underwent pulmonary lobectomy by means of thoracotomy (n = 12,860) or VATS (n = 759). Student's t and chi(2) tests were used to compare the two groups. Multivariable analysis was used to identify independent predictors of outcome measures. RESULTS: The two groups of patients had similar demographics and preoperative comorbidities. They also had similar in-hospital mortality rates (3.1% versus 3.4%; p = 0.67); lengths of stay (9.3 +/- 0.1 versus 9.2 +/- 0.4 days; p = 0.84); hospitalization costs ($23,862 +/- $206 versus $25,125 +/- $1,093; p = 0.16); and rates of wound infection (0.8% versus 1.3%; p = 0.15), pulmonary complications (32.2% versus 31.2%; p = 0.55), and cardiovascular complications (3.4% versus 3.9%; p = 0.43). However, multivariable analysis showed that the VATS group had a significantly higher incidence of intraoperative complications than the thoracotomy group (odds ratio, 1.6; 95% confidence interval, 1.0 to 2.4; p = 0.04). A higher percentage of patients with annual income greater than $59,000 underwent VATS lobectomy than patients with income less than $59,000 (35.7% versus 25.4%; p < 0.0001). CONCLUSIONS: Patients who underwent VATS lobectomy were 1.6 times more likely to have intraoperative complications than patients who underwent open lobectomy. However, short-term mortality, lengths of stay, and hospitalization costs were similar between the two groups of patients. There seems to be a socioeconomic disparity between VATS and open thoracotomy patients. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/20417778/Video_assisted_thoracoscopic_versus_open_thoracotomy_lobectomy_in_a_cohort_of_13619_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(10)00402-9 DB - PRIME DP - Unbound Medicine ER -