Comparing Thoracoscopic and Robotic Lobectomy Using a Nationally Representative Database

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Health Economics

Background:

• Robotic lobectomy (Robot-L) studies often use data from specialized centers, limiting generalizability.
• National data is crucial for understanding the broader implications of Robot-L versus traditional methods.

Purpose of the Study:

• To compare mortality, length of stay (LOS), and costs between Robot-L and video-assisted thoracoscopic lobectomy (VATS-L).
• To analyze outcomes using a nationally representative patient database.

Main Methods:

• Utilized the Premier Healthcare Database (2009-2019) for elective lung cancer lobectomies.
• Employed ICD-9/10 codes to categorize Robot-L and VATS-L procedures.
• Applied survey methodology and propensity matching for robust, generalizable comparisons.

Main Results:

• A propensity-matched cohort of 62,698 patients showed similar in-hospital mortality for Robot-L and VATS-L (0.9% vs. 0.9%).
• Robot-L patients experienced shorter LOS (4 vs. 5 days) but incurred higher charges (approx. $17,860 more).

Conclusions:

• Robot-L and VATS-L demonstrate comparable mortality in a national dataset.
• Despite shorter hospitalization, Robot-L's higher cost necessitates further evaluation of its cost-effectiveness.
• Given Robot-L's increasing prevalence, understanding its value proposition is critical.