Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data

Abstract

Robotic-assisted lobectomy (RL) is becoming a popular alternative technique to video-assisted thoracoscopic lobectomy (VL), although open lobectomy (OL) remains the most common approach. The objective of this study is to provide a comparative analysis of perioperative clinical outcomes from elective RL, VL, and OL. The Premier Healthcare Database was analyzed for lobectomies performed from January 1, 2011, to September 30, 2015. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes were used to identify surgical approaches, complications, and mortality. Propensity score matching (1:1) for patient and hospital characteristics allowed comparison of RL versus OL (n= 2,775 each) and RL versus VL (n= 2,951 each). Compared with OL in propensity matched analysis, RL was associated with a lower postoperative complication rate (p < 0.0001), shorter hospital stay (p < 0.0001), and lower mortality rate (p= 0.0282). Patients in the RL group were more likely to be discharged home than to a transitional health care facility (p < 0.0001). Compared with VL, the RL group had a lower conversion rate to thoracotomy (p < 0.0001), lower overall postoperative complication rate (p= 0.0061), and shorter hospital stay (p= 0.006). The RL patients also were more likely to be discharged home than to a transitional health care facility (p= 0.0108). The postoperative mortality rates of RL and VL were similar (p= 0.44). There was no difference in iatrogenic injuries when comparing RL with OL and RL with VL (p= 0.1284 and p= 0.5477, respectively). Robotic-assisted lobectomy was associated with improved outcomes for certain perioperative clinical variables, including shorter length of stay and lower complication rates. It was also was associated with a lower conversion rate to OL compared with VL.