Comparative Effectiveness of Robotic-Assisted vs Thoracoscopic Lobectomy

• Published in: Chest Vol. 146; no. 6; pp. 1505 - 1512
• Main Authors: Paul, Subroto, MD, FCCP, Jalbert, Jessica, PhD, MD, Isaacs, Abby J., MS, Altorki, Nasser K., MD, FCCP, Isom, O. Wayne, MD, Sedrakyan, Art, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2014
• Subjects: Adult; Aged; Cohort Studies; Cost-Benefit Analysis; Female; Follow-Up Studies; Hospital Mortality - trends; Humans; Length of Stay - economics; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pneumonectomy - economics; Pneumonectomy - methods; Pneumonectomy - mortality; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Pulmonary/Respiratory; Retrospective Studies; Risk Assessment; Robotic Surgical Procedures - economics; Robotic Surgical Procedures - methods; Robotic Surgical Procedures - mortality; Thoracic Surgery, Video-Assisted - economics; Thoracic Surgery, Video-Assisted - methods; Thoracic Surgery, Video-Assisted - mortality; Treatment Outcome; United States; United States; NIS; FDA; US Food and Drug Administration; Healthcare Cost and Utilization Project; Nationwide Inpatient Sample; HCUP
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.13-3032

Abstract BACKGROUND: Robotic-assisted lobectomy is being offered increasingly to patients. However, little is known about its safety, complication profile, or effectiveness. METHODS: Patients undergoing lobectomy in in the United States from 2008 to 2011 were identified in the Nationwide Inpatient Sample. In-hospital mortality, complications, length of stay, and cost for patients undergoing robotic-assisted lobectomy were compared with those for patients undergoing thoracoscopic lobectomy. RESULTS: We identified 2,498 robotic-assisted and 37,595 thoracoscopic lobectomies performed from 2008 to 2011. The unadjusted rate for any complication was higher for those undergoing robotic-assisted lobectomy than for those undergoing thoracoscopic lobectomy (50.1% vs 45.2%, P < .05). Specific complications that were higher included cardiovascular complications (23.3% vs 20.0%, P < .05) and iatrogenic bleeding complications (5.0% vs 2.0%, P < .05). The higher risk of iatrogenic bleeding complications persisted in multivariable analyses (adjusted OR, 2.64; 95% CI, 1.58-4.43). Robotic-assisted lobectomy costs significantly more than thoracoscopic lobectomy ($22,582 vs $17,874, P < .05). CONCLUSIONS: In this early experience with robotic surgery, robotic-assisted lobectomy was associated with a higher rate of intraoperative injury and bleeding than was thoracoscopic lobectomy, at a significantly higher cost.