A. Osasona2, H. Mehta2, J. Goodwin3, K. Brown2, I. Okereke1 1University Of Texas Medical Branch,Cardiothoracic,Galveston, TX, USA 2University Of Texas Medical Branch,Surgery,Galveston, TX, USA 3University Of Texas Medical Branch,Internal Medicine,Galveston, TX, USA
Introduction:
Nationwide, video assisted thoracoscopic surgery (VATS) is being utilized with increasing frequency for pulmonary resection. VATS lobectomy is associated with less morbidity than open lobectomy. There appears to be a disparate rate of utilization of VATS across different patient populations, however. Our goal was to determine which factors affect a patient’s likelihood of undergoing VATS versus open lobectomy.
Methods:
The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 through 2014 to identify all patients undergoing pulmonary lobectomy. Multivariable logistic regression was conducted to identify patient demographics, clinical characteristics and surgeon specialty associated with an increased likelihood of receiving a VATS lobectomy versus an open approach.
Results:
From 2005 through 2014, 11,977 patients in the NSQIP database underwent lobectomy (open, 6,391; VATS, 5,586). The mean age was 64.4 years and females comprised 53.4% of cases. The use of VATS lobectomy increased significantly over time, increasing from 17.5% in 2005—2008 to 53.1% in 2012—2014 (p<0.001). On multivariable analysis, male gender (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.12-1.30), African-American race (OR, 1.22; 95% CI, 1.04-1.43), age under 75 years (OR, 1.21; 95% CI, 1.11-1.32), worse frailty index (OR, 1.56; 95% CI, 1.06-2.28) and performance of the lobectomy by someone other than a non-cardiac thoracic surgeon (OR, 1.37; 95% CI, 1.25-1.51) were associated with an increased likelihood of receiving an open lobectomy.
Conclusion:
The frequency of VATS lobectomy has increased substantially over the last 10 years, and now accounts for over half of the lobectomies performed at NSQIP hospitals. Demographics, clinical characteristics, and specialty of surgeon influences a patient’s likelihood of receiving VATS versus open lobectomy. Identifying such disparities in surgical approach may help to direct the focus of interventions at the individual, hospital or organizational level to increase the use of VATS lobectomy.