Cost-effectiveness and postoperative outcomes of spontaneous vs. mechanical ventilation during video-assisted thoracoscopic surgery: a retrospective study.

Abstract

Video-assisted thoracoscopic surgery (VATS) is known to have the advantages of being minimally invasive, reducing complications, and shortening hospitalization time. However, related cost surveys have been inconsistent. In recent years, a new concept of tubeless anesthesia has been introduced, but its impact on the cost-effectiveness of VATS is unclear. This study compared the hospitalization costs and postoperative outcomes in patients undergoing spontaneous ventilation VATS (SV-VATS) and mechanical ventilation VATS (MV-VATS). We retrospectively analyzed data on the VATS procedures performed at the Shaoxing People's Hospital from June 2022 to July 2023. Overall, 386 patients who met the inclusion criteria were treated with SV-VATS (n=57) or MV-VATS (n=329). Comprehensive cost comparisons were performed between the groups. The two groups shared comparable clinical characteristics, such as age (P=0.64), sex (P=0.72), body mass index (BMI) (P=0.68), and type of procedure (P=0.43). All costs are expressed in U.S. dollars ($). The overall, diagnostic, operation, and material costs of SV-VATS and MV-VATS were $3,858.71±$746.32 vs. $3,870.26±$990.69 (P=0.94), $911.83 vs. $908.73 (P=0.51), $875.58 vs. $875.58 (P=0.51), and $1,560.5 vs. $1,596.91±$727.18 (P=0.31), respectively. In addition, the median costs of anesthesia materials and total medications were $233.51 vs. $324.02 and $290.63 vs. $364.14, respectively (P<0.001). Among medications, the cost of anesthesia medicine was $179.6±$45.48 vs. $224.12±$54.67, respectively (P<0.001). Postoperative complications, including sore throat, hoarseness, and expectoration, did not occur in the SV-VATS group, whereas 13, 11, and 10 cases were noted, respectively, in the MV-VATS group (13.5%, 11.5%, and 10.4%, respectively; P=0.01, P=0.03, P=0.041). The time to extubation in the SV-VATS and MV-VATS groups was 4 and 10 min, respectively (P<0.001). No intermediate surgery was performed in either group. Compared with SV-VATS, MV-VATS can reduce patients' anesthesia and medicine costs and has similar postoperative adverse event rates in VATS patients, which is conducive to accelerating patient recovery. Therefore, tubeless anesthesia is recommended for future VATS.