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The Annals of Thoracic Surgery, Vol 58, 1595-1598, Copyright © 1994 by The Society of Thoracic Surgeons
LJ Molin, JB Steinberg and LA Lanza
Proliferation in the use of video-assisted thoracic surgery (VATS) has
occurred without data demonstrating benefit. Few studies have critically
compared VATS with limited thoracotomy (LT) in homogeneous patient
populations undergoing standardized procedures. We retrospectively reviewed
the hospital records of 37 consecutive patients referred for elective lung
biopsy as part of an ongoing interstitial lung disease protocol to
determine whether VATS improved outcome or reduced costs. Sixteen patients
underwent VATS, and 21 patients underwent LT lung biopsy over a 31 month
period. The two groups were homogeneous in regard to clinical symptoms,
radiologic findings, age, sex, and preoperative pulmonary function. The
operative mortality was not different between the two groups (VATS, 0/16,
and LT, 1/21). The postoperative stay was 4.8 +/- 1.0 days for VATS and 5.0
+/- 0.5 days for LT (p = not significant). Operating time, number of
specimens obtained, chest tube output, and day of chest tube removal did
not differ. There was no difference in the amount of analgesics required
during the postoperative period. Operating room cost for VATS was
significantly greater than that for LT ($2,663 +/- $384 versus $1,801 +/-
$94; p = 0.04) despite the use of nondisposable equipment.
Anesthesia-related costs were also greater for VATS ($309 +/- $11 versus
$244 +/- $15; p = 0.002). In conclusion, lung biopsy in patients with
interstitial lung disease can be performed safely and efficiently with
either VATS or LT, but VATS results in higher procedure-related costs.
ARTICLES
VATS increases costs in patients undergoing lung biopsy for interstitial lung disease
Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242.
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