Cost analysis of video-assisted thoracic surgery versus thoracotomy: critical review

Cost containment has become an important issue in thoracic surgery. Applying the principles of evidence-based medicine a literature search was performed to determine whether video-assisted thoracic surgery (VATS) has an advantage over thoracotomy concerning total cost. Only eight studies specifically looked at cost; all but one were retrospective. Lung biopsy by VATS yielded higher operating room costs compared with limited thoracotomy. The cost of VATS wedge resection of lung nodules was competitive with open techniques. In a prospective study regarding the treatment of pneumothorax by VATS, no advantages were demonstrated compared with axillary minithoracotomy. In two retrospective studies the total economic cost of VATS was lower but not all relevant factors were considered. Lung volume reduction surgery by VATS had a lower total inpatient cost compared with sternotomy but no specific details were provided. Finally, VATS treatment of lung cancer yielded conflicting results regarding total hospital charges. From these studies it is clear that video-assisted thoracic surgery has a higher initial cost. Whether this is offset by a more rapid discharge remains to be proven. There is a definite need for high-quality prospective randomised studies.