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Eur J Cardiothorac Surg 2009;35:423-428. doi:10.1016/j.ejcts.2008.11.008
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Video-assisted thoracic surgery lobectomy: can we afford it?

Gianluca Casali*, William S. Walker

Cardiothoracic Surgery Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

Received 21 July 2008; received in revised form 24 October 2008; accepted 7 November 2008.

* Corresponding author. Address: D Level North Wing, Mailpoint 46, Southampton General Hospital, Tremona Road, SO16 6YD, Southampton, UK. Tel.: +44 23 8079 5935/5911; fax: +44 23 8079 4526. (Email: gianlucasali{at}yahoo.com).

Introduction: Although video-assisted thoracoscopic (VATS) lobectomy offers advantages with regard to pain, respiratory function and mobility, concern is often expressed concerning the cost of stapling devices and increased operative time. We have therefore compared the costs of VATS and open lobectomy in order to assess the overall economic sustainability of a VATS programme. Materials and methods: Between January 2004 and December 2006 346 patients underwent pulmonary lobectomy mainly for stage I or II lung cancer (93 VATS lobectomy, 253 thoracotomy). In the VATS group 47% of patients had an upper lobectomy versus 52% in the open group (p = ns). Direct medical costs (disposables, theatre time, high dependency unit stay, hospital stay) were determined and stratified by lobectomy type. Results: Mean theatre cost for a VATS lobectomy was 2533 ± 230\#8364; versus 1280 ± 54\#8364; for a thoracotomy lobectomy (p = 0.00001). Mean high dependency unit (HDU) cost was 1713 ± 236\#8364; and 2571 ± 80\#8364; for a VATS and a thoracotomy lobectomy, respectively (p = 0.00001). Mean cost of hospital stay for a VATS lobectomy was 3776 ± 281\#8364; versus 4325 ± 154\#8364; for an open one (p = 0.00001). The overall cost for a VATS lobectomy was 8023 ± 565\#8364; which was less than an open lobectomy 8178 ± 167\#8364; (p = 0.0002). VATS bilobectomy was slightly more expensive than an open one: 8702 ± 350\#8364; versus 8655 ± 466\#8364; but this difference (47\#8364;) was not significant (p = ns). Conclusion: VATS lobectomy is less expensive than conventional lobectomy. Increased theatre costs (disposables and time) are counteracted by shorter hospital stay. Importantly, the reduced HDU and ward bed stays free resources for other patients.

Key Words: Lung cancer • Lung resection • VATS • Cost-effectiveness • Minimally invasive surgery • Thoracoscopy






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Copyright © 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.