I. C. Bostock1, F. Sheikh1, T. M. Millington1, D. J. Finley1, J. D. Philips1 1Dartmouth Hitchcock Medical Center,Thoracic Surgery,Lebanon, NH, USA
Introduction:
Anatomic resection is the standard of care for early-stage lung cancer. Video-assisted thoracoscopic surgery (VATS) has been established as a safe and effective alternative to an open approach. The aims of this study were to: 1) Characterize open versus VATS surgical practice trends for the management of lung cancer in the United States, and 2) Describe if particular regions of the country utilize minimally invasive surgery more frequently.
Methods:
Using the Dartmouth Atlas Rate Generator, the population of Medicare beneficiaries from the ages of 65 to 99 years with full Part A and B coverage and no HMO coverage for the years of 2006 and 2014 was selected. The diagnosis of lung cancer (ICD-9 codes: 162.0 162.2 162.3 162.4 162.5 162.8 162.9) with subsequent selection of CPT codes to describe thoracoscopic (32601, 32607, 32655, 32663, 32666, 32667, 32668, 32669, 32670, 32671) and open lung resections (32096, 32097, 32141, 32505, 32506, 32507, 32608, 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488) were queried. Comparison of data between 2006 and 2014 with descriptive statistics and a univariate analysis were performed using student’s t-test and chi-square, as appropriate. A p-value <0.05 was considered statistically significant. Heat maps were generated based on the distribution of cases by geographic region.
Results:
A total of 24,368,333 and 23,921,059 patients for the years of 2006 and 2014, were analyzed. A diagnosis of lung cancer was made in 167,418 patients (0.7%) and 167,506 patients (0.7%) in 2006 and 2014 (p=0.7), respectively. A surgical intervention was performed in 17,249 patients (10.3%) during 2006 and 18,603 patients (11.1%) in 2014 (p=0.01). A VATS approach was performed in 2,512 patients (15%) during 2006 and 9,578 patients (54%) during 2014 (p=0.01). In 2006, California, New York, and New Jersey performed the most VATS procedures, in comparison to 2014, when New York, Florida, and California performed the most VATS procedures.
Conclusion:
The incidence of lung cancer in the United States was unchanged from the period of 2006 to 2014. A change in surgical practice patterns was evident, with a significant increase in the use of VATS techniques in more than 50% of cases after this eight-year period. This indicates that VATS has become the preferred technique in the population studied.
