Choice between video-assisted thoracic surgery and thoracotomy: importance of required operative time and blood transfusion.

Abstract

The current evidence in support of Video-assisted thoracic surgery (VATS) over conventional open thoracotomy is based upon outcomes related to perioperative complications. The aim of the current study was to compare the mean operative time and amount of blood transfusion required for VATS and thoracotomy. A retrospective data analysis was carried out of all patients undergoing pulmonary surgery in the year 2017 for either for benign or malignant conditions at our institute. The primary outcomes were mean operative times and amounts of blood transfusion required during the procedure. Adjusted regression models were used to draw an association between the type of surgical modality (VATS or thoracotomy) and the outcomes considered. There were 278 subjects that underwent VATS and 237 that had thoracotomy. The mean operating time for the VATS group (2.58 ± 0.98 hours) was significantly less than that of the thoracotomy group (2.99 ± 1.18 hours). Similarly, the amounts of combined blood and plasma transfused were significantly less with VATS (5.81±6.3 units) as compared to the thoracotomy group (9.9 ± 15.1 units). VATS also required significantly fewer blood units as compared to thoracotomy (3.79 ± 3.1 vs. 7.15 ± 12.3). Our analysis indicated that, with VATS, the requirement of blood and plasma transfusion was reduced by nearly 4 units (b=-4.09; 95% CI: -6.04, -2.14) and the mean operative time was reduced by around 40 minutes (b=-0.41; 95% CI: -0.60, -0.22). Both VATS and thoracotomy are acceptable surgical techniques for the management of lung pathology. However, VATS technique is associated with lower need for blood transfusion and reduced operating time. The decision of the surgical technique should be guided by the availability of resources and the skills of the surgeon.