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Saving the split: the benefits of VATS thymectomy
Daniel J Gross1, Bardiya Zangbar1, Nagarajan Muthu2
1Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA.
Journal of Thoracic Disease
|June 11, 2019
Summary
Video-assisted thoracoscopic surgery (VATS) thymectomy offers reduced hospital stays and lower costs compared to standard sternotomy thymectomy. This minimally invasive approach is increasingly adopted due to its favorable healthcare and financial outcomes.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Surgery
- Health Economics
Background:
- Traditional sternotomy thymectomy is being challenged by minimally invasive techniques.
- The adoption of video-assisted thoracoscopic surgery (VATS) signifies a shift in surgical approaches.
- Comparative analysis of VATS versus sternotomy thymectomy is crucial for understanding modern surgical practices.
Purpose of the Study:
- To compare the financial costs and healthcare outcomes of VATS thymectomy against standard sternotomy thymectomy.
- To evaluate the trends in the utilization of VATS thymectomy over a defined period.
- To identify the independent predictors of hospital length of stay and charges associated with each surgical approach.
Main Methods:
- A retrospective review of the National Inpatient Sample (NIS) database from 2010-2012.
- Inclusion of all patients who underwent thymectomy, with specific identification of VATS thymectomy cases.
- Statistical analysis including univariate and multivariate models to compare outcomes (length of stay, hospital charges, mortality) while controlling for patient demographics and comorbidities.
Main Results:
- Analysis of 2,065 thymectomy cases: 373 (18.1%) VATS and 1,692 (81.9%) standard sternotomy.
- Significant increase in VATS thymectomy prevalence from 10% in 2010 to 19.2% in 2012 (P<0.001).
- VATS thymectomy patients experienced shorter hospital LOS (3.3d vs. 6.8d), lower hospital charges ($57,251 vs. $88,838), and no mortality (0% vs. 0.9%) compared to sternotomy (P<0.001 for LOS and charges, P=0.01 for mortality).
- Multivariate analysis confirmed sternotomy was independently associated with increased LOS (B=1.6d, P<0.001) and charges (B=$13,041, P=0.041).
Conclusions:
- VATS thymectomy is associated with significantly decreased hospital length of stay and reduced hospital charges compared to standard sternotomy.
- The increasing prevalence of VATS thymectomies suggests a trend towards adoption of this approach due to its favorable outcomes.
- These findings support VATS thymectomy as a cost-effective and efficient alternative to sternotomy for appropriate patient populations.
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