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J Thorac Cardiovasc Surg. 2018 Mar;155(3):1267-1277.e1. doi: 10.1016/j.jtcvs.2017.08.146. Epub 2017 Nov 13.

Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes.

Author information

1
Stanford University School of Medicine, Stanford, Calif.
2
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
3
Stanford Health Care, Stanford, Calif.
4
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif. Electronic address: shrager@stanford.edu.

Abstract

OBJECTIVE:

To determine whether surgeon selection of instrumentation and other supplies during video-assisted thoracoscopic lobectomy (VATSL) can safely reduce intraoperative costs.

METHODS:

In this retrospective, cost-focused review of all video-assisted thoracoscopic surgery anatomic lung resections performed by 2 surgeons at a single institution between 2010 and 2014, we compared VATSL hospital costs and perioperative outcomes between the surgeons, as well as costs of VATSL compared with thoracotomy lobectomy (THORL).

RESULTS:

A total of 100 VATSLs were performed by surgeon A, and 70 were performed by surgeon B. The preoperative risk factors did not differ significantly between the 2 groups of surgeries. Mean VATSL total hospital costs per case were 24% percent greater for surgeon A compared with surgeon B (P = .0026). Intraoperative supply costs accounted for most of this cost difference and were 85% greater for surgeon A compared with surgeon B (P < .0001). The use of nonstapler supplies, including energy devices, sealants, and disposables, drove intraoperative costs, accounting for 55% of the difference in intraoperative supply costs between the surgeons. Operative time was 25% longer for surgeon A compared with surgeon B (P < .0001), but this accounted for only 11% of the difference in total cost. Surgeon A's overall VATSL costs per case were similar to those of THORLs (n = 100) performed over the same time period, whereas surgeon B's VATSL costs per case were 24% less than those of THORLs. On adjusted analysis, there was no difference in VATSL perioperative outcomes between the 2 surgeons.

CONCLUSIONS:

The costs of VATSL differ substantially among surgeons and are heavily influenced by the use of disposable equipment/devices. Surgeons can substantially reduce the costs of VATSL to far lower than those of THORL without compromising surgical outcomes through prudent use of costly instruments and technologies.

KEYWORDS:

VATSL; choice of instrumentation; cost and cost analysis; cost savings; cost-conscious; cost-effectiveness; instrumentation; lobectomy; lung cancer; lung neoplasms; mesh; pulmonary resection; reduce cost; thoracic surgery; video-assisted thoracotomy; wedge resection

Comment in

PMID:
29224839
DOI:
10.1016/j.jtcvs.2017.08.146
[Indexed for MEDLINE]

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