Association of tumor location with economic outcomes and air leak complications in thoracic lobectomies: results from a national hospital billing dataset
Authors Bhora F, Ghosh SK, Kassis E, Yoo A, Ramisetti S, Johnston SS, Rehmani S, Kalsekar I
Received 12 October 2018
Accepted for publication 26 March 2019
Published 6 June 2019 Volume 2019:11 Pages 373—383
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Samer Hamidi
Faiz Bhora,1 Sudip K Ghosh,2 Edmund Kassis,3 Andrew Yoo,4 Sushama Ramisetti,4 Stephen S Johnston,4 Sadiq Rehmani,5 Iftekhar Kalsekar4
1Health Quest Health System, Poughkeepsie, NY 12601, USA; 2Global Health Economics and Market Access, Ethicon, Inc., Cincinnati, OH, USA; 3Medical Affairs, Ethicon, Inc., Cincinnati, OH, USA; 4Medical Devices - Epidemiology, Johnson and Johnson, New Brunswick, NJ, USA; 5Department of Thoracic Surgery, Mount Sinai St. Luke‘s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Purpose: To assess whether tumor location during thoracic lobectomies affects economic outcomes or air leak complications.
Patients and methods: Retrospective, observational study using Premier Healthcare Database. The study included patients aged ≥18 years who underwent elective inpatient thoracic lobectomy for lung cancer between 2012 and 2014 (first qualifying=index admission). Three mutually exclusive tumor location groups were formed: upper lobe, middle lobe, and lower lobe. Primary outcomes were index admission’s length of stay (LOS), total hospital costs, and operating room time; in-hospital air leak complications (composite of air leak/pneumothorax) served as an exploratory outcome. Multivariable models were used to examine the association between tumor location and the study outcomes, accounting for covariates and hospital-level clustering.
Results: 8,750 thoracic lobectomies were identified: upper lobe (n=5,284), middle lobe (n=512), and lower lobe (n=2,954). Compared with the upper lobe, the middle and lower lobe groups had statistically significant (p<0.05): shorter adjusted LOS (7.0 days upper vs 5.8 days middle, 6.6 days lower), lower adjusted mean total hospital costs ($26,177 upper vs $23,109 middle, $24,557 lower), and lower adjusted odds of air leak complications (odds ratio middle vs upper=0.81, 95% CI=0.74–0.89; odds ratio lower vs upper=0.60, 95% CI=0.46–0.78). Findings were similar but varied in statistical significance when stratified by open and video-assisted thoracoscopic surgery approach.
Conclusion: Among patients undergoing elective thoracic lobectomy for lung cancer in real-world clinical practice, upper lobe tumors were significantly associated with increased in-hospital resource use and air leak complications as compared with lower or middle lobe tumors.
Keywords: thoracic lobectomy, costs, length of stay, cancer
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]