Has VATS Become Too Expensive? A Cost Analysis of VATS versus Open Lobectomy in a Canadian Tertiary Care Hospital

Background: Video-assisted thoracoscopic surgery (VATS) lobectomy is a minimally invasive anatomic lung resection that has been associated with decreased pain and hospital stay compared to open resection. However, with the higher costs of disposable VATS instruments it is unclear whether or not the overall hospital costs are equivalent. The objectives of this study are to compare the overall in-hospital costs of VATS to open lobectomy and assess the financial impact of performing VATS lobectomy procedures in a Canadian tertiary care hospital. Methods: A retrospective cost analysis was done comparing 78 VATS to 151 open lobectomies. Intraoperative costs, postoperative costs, total costs and length of hospital stay were compared. A regression analysis was done adjusting for age, gender, tumor size and tumor stage. Results: The mean intraoperative, postoperative and total costs for VATS and open lobectomy were $4,770 and $2,166 (p=0.01), $3929 and $5,604 (p<0.0001), and $8,499 and $7,771 (p=0.3), respectively. The median hospital stay for VATS and open lobectomy were 4 and 5 days (p<0.0001), respectively. The mean intraoperative costs of VATS lobectomy in the first and second 39 VATS lobectomies were $4894 and $4246 (p = 0.003), respectively. Conclusions: The total cost of VATS lobectomy is equivalent to open lobectomy. Increased cost of disposables and longer operating time account for higher intraoperative cost of VATS lobectomy. A shorter hospital stay and lack of requirement for the acute pain service (APS) reduce the postoperative cost of VATS. The intraoperative costs of VATS lobectomies decrease with experience.