Clinical and economic comparative effectiveness of robotic-assisted, video-assisted thoracoscopic, and open lobectomy.

Background: We sought to evaluate trends and clinical and economic outcomes between robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VL), and open pulmonary lobectomy (OL).
Methods: Patients who underwent a lobectomy for malignancy from January 1, 2008, to September 30, 2015, were identified in the Premier Healthcare Database. Propensity score matched (PSM) comparisons were performed between RL versus VL and RL versus OL. Patient characteristics were applied to generate propensity scores. In-hospital and perioperative 30-day outcomes and costs were compared within matched cohorts.
Results: From 2008 to 2015, there was a marked decline for OL (71% to 43%, P<0.0001) with a significant increase in RL (1% to 17%, P<0.0001) and VL (28% to 41%, P<0.0001). In the early period (January 2008 to December 2012), total operating room time was longer (P<0.0001) and admission to ICU was more common for RL compared to VL or OL (P<0.0001) although the total length of ICU stay was shorter for RL compared to VL or OL (P<0.0001). In the late period (January 2013 to September 2015), RL was associated with significantly lower rates of complications (P<0.05), conversions, and shorter length of stay than VL and OL. When hospital volume was not considered, costs were higher for RL than VL and OL. In hospitals where >25 lobectomies were performed annually, the total cost of RL was comparable to VL (P=0.09) and OL (P=0.11).
Conclusions: During the study period, the utilization of RL increased substantially and was associated with improved perioperative outcomes compared with VL and OL. When annual hospital volume was >25 cases, these clinical advantages persisted and there was no significant cost difference between RL, VL, or OL. RL is an effective and cost-comparable approach for lobectomy in patients with lung malignancy.
Competing Interests: Conflicts of Interest: IS Sarkaria serves as the unpaid editorial board member of Journal of Thoracic Disease from Sep 2018 to Aug 2020 and he is consultant and teacher for Intuitive. IS Sarkaria: consultant and teacher for Intuitive. DS Oh is a part-time employee of Intuitive as a medical advisor and C Song and E Liu are full-time employees of Intuitive, during the conduct of the study. L Shi serves as a consultant to Intuitive. The other authors have no conflicts of interest to declare. All authors had full access to all of the data in the study and accept responsibility for the integrity of the data and the accuracy of the data analysis.
(2020 Journal of Thoracic Disease. All rights reserved.)