Send to

Choose Destination
Eur J Cardiothorac Surg. 2017 Jan;51(1):169-174. doi: 10.1093/ejcts/ezw239. Epub 2016 Jul 25.

The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies.

Author information

Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA



Video-assisted thoracoscopic surgery (VATS) lobectomy is quickly becoming the standard of care for many patients with early-stage non-small-cell lung cancer (NSCLC) and benign lung conditions. There is a lack of published data defining the differential impact of preoperative patient comorbidity on outcomes following VATS and OPEN lobectomies, which would be beneficial for procedure selection and clinical decision-making.


A retrospective analysis of the 2008-2011 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP) database was performed. Demographic and clinical data on patients ≥18 years having undergone VATS or OPEN lobectomy were included. Measured outcomes included postoperative length of stay (PO-LOS), in-hospital mortality and perioperative pulmonary complications. PO-LOS was further analysed using multivariable logistic regression and cumulative incidence models.


VATS lobectomies were associated with shorter PO-LOS and fewer complications even after censoring for inpatient mortality. Furthermore, VATS lobectomy patients had improved PO-LOS compared with OPEN lobectomy patients, even with greater comorbidity. Logistic regression modelling for PO-LOS ≥14 days identified independent predictors of prolonged PO-LOS, including male gender, non-elective admission, lower hospital lobectomy volume, several Elixhauser comorbidities and performance of OPEN lobectomy.


The expected postoperative length of stay for a patient treated by OPEN lobectomy is approximately equal to that of a VATS lobectomy patient with an additional 2-3 comorbidities. The VATS approach remains advantageous with respect to PO-LOS, regardless of the number of comorbidities.


Lobectomy; Thoracoscopic; VATS

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center