Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database

• Published in: European journal of cardio-thoracic surgery 2013-04, Vol.43 (4), p.813-817
• Main Authors: Paul, Subroto, Sedrakyan, Art, Chiu, Ya-lin, Nasar, Abu, Port, Jeffrey L., Lee, Paul C., Stiles, Brendon M., Altorki, Nasser K.
• Format: Article
• Language: English
• Subjects: Aged; Cohort Studies; Databases, Factual; Female; Humans; Length of Stay; Lung Neoplasms - surgery; Male; Middle Aged; Morbidity; Pneumonectomy - methods; Pneumonectomy - mortality; Postoperative Complications - epidemiology; Thoracoscopy - methods; Thoracoscopy - mortality; Thoracotomy - methods; Thoracotomy - mortality; Treatment Outcome; United States - epidemiology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezs428

OBJECTIVES We examined the Nationwide Inpatient Sample (NIS) database to compare short-term postoperative outcomes following open and thoracoscopic lobectomy. Thoracoscopic (video-assisted thoracic surgery) lobectomy has been demonstrated to be associated with fewer postoperative complications compared with open thoracotomy lobectomy in several large case series. However, as no randomized trial has been performed, there are many who question this. METHODS We examined the NIS database for all patients undergoing lobectomy as their principal procedure either via thoracoscopic or open thoracotomy from 2007 to 08. We compared the postoperative outcomes of these two groups of patients after propensity matching these groups based on several preoperative variables. RESULTS Over a 2-year-period, 68 350 patients underwent a lobectomy by either thoracoscopy [n = 10 554 (15%)] or thoracotomy [n = 57 796(85%)]. Thirty-two percent of thoracoscopic lobectomies (n = 3421) were performed in either rural or non-teaching urban centres. Although in propensity-matched cohorts there was no difference in operative mortality, thoracoscopic lobectomy was associated with a lower incidence of postoperative complications [n = 4146 (40.8%) vs n = 13 913 (45.1%), P < 0.001] and shorter length of stay (5.0 vs 7.0 days; P < 0.001) compared with open lobectomy. Specifically, the incidences of supraventricular arrhythmias, myocardial infarction, pulmonary embolism and empyema were lower. CONCLUSIONS This large national database study demonstrates that thoracoscopic lobectomy is associated with fewer in-hospital postoperative complications compared with open lobectomy. Thoracoscopic lobectomy appears to be applicable to the wider general thoracic surgical community.