The Impact of Thoracoscopic Surgery on Payment and Health Care Utilization After Lung Resection

Background. Lung resection by video-assisted thoracoscopic surgery (VATS) is associated with multiple clinical benefits compared with resection by thoracotomy (OPEN). Less is known about reimbursements, costs, and resource use with each approach. This study used a commercial insurance claims database to examine differences between VATS and OPEN lung resections in payment, health care utilization, and estimated days off work for health care visits. Methods. All adult inpatient discharges for patients undergoing VATS or OPEN lung resection in 2010 were identified from the Truven MarketScan Database (Ann Arbor, MI). Results. A total of 2,611 patients underwent lobectomy (VATS, 270; OPEN, 669) or wedge resection (VATS, 1,332; OPEN, 340). After adjustment, OPEN lobectomies had a longer length of stay (mean difference, 1.79 days) and higher payment to hospitals (mean difference, $3,497) and physicians (mean difference, $433) compared with VATS. Similar findings were noted after wedge resections. OPEN lobectomies had 1.28-times and 1.14-times more health care utilization days within 90 days and 365 days, respectively, after the operation compared with VATS, translating into increased expenditures of $3,260 at 90 days and $822 at 365 days for OPEN procedures. No significant differences in utilization were noted between OPEN and VATS wedge resections, except for fewer outpatient visits within 90 days in the OPEN group. Conclusions. Compared with an OPEN approach, lobectomy and wedge resection by VATS were associated with lower hospital and physician payments. In addition, lobectomy by VATS was associated with less health care utilization in the early postoperative period and during the first year after the operation. These payment and utilization reductions are important in an era of value based purchasing in health care. (C) 2016 by The Society of Thoracic Surgeons