VATS increases costs in patients undergoing lung biopsy for interstitial lung disease

Proliferation in the use of video-assisted thoracic surgery (VATS) has occurred without data demonstrating benefit. Few studies have critically compared VATS with limited thoracotomy (LT) in homogeneous patient populations undergoing standardized procedures. We retrospectively reviewed the hospital records of 37 consecutive patients referred for elective lung biopsy as part of an ongoing interstitial lung disease protocol to determine whether VATS improved outcome or reduced costs. Sixteen patients underwent VATS, and 21 patients underwent LT lung biopsy over a 31 month period. The two groups were homogeneous in regard to clinical symptoms, radiologic findings, age, sex, and preoperative pulmonary function. The operative mortality was not different between the two groups (VATS, 0/16, and LT, 1/21). The postoperative stay was 4.8 +/- 1.0 days for VATS and 5.0 +/- 0.5 days for LT (p = not significant). Operating time, number of specimens obtained, chest tube output, and day of chest tube removal did not differ. There was no difference in the amount of analgesics required during the postoperative period. Operating room cost for VATS was significantly greater than that for LT ($2,663 +/- $384 versus $1,801 +/- $94; p = 0.04) despite the use of nondisposable equipment. Anesthesia-related costs were also greater for VATS ($309 +/- $11 versus $244 +/- $15; p = 0.002). In conclusion, lung biopsy in patients with interstitial lung disease can be performed safely and efficiently with either VATS or LT, but VATS results in higher procedure-related costs.