Top

Published in:

14-12-2022 | Original Article

The impact of an enhanced recovery after surgery pathway for video-assisted and robotic-assisted lobectomy on surgical outcomes and costs: a retrospective single-center cohort study

Authors: Shiwei Han, Simo Du, Christina Jander, Madhan Kuppusamy, Joel Sternbach, Donald E. Low, Michal Hubka

Published in: Journal of Robotic Surgery | Issue 3/2023

Abstract

To determine the impact of enhanced recovery after surgery (ERAS) pathway implementation on outcomes and cost of robotic- and video-assisted thoracoscopic (RATS and VATS) lobectomy. Retrospective review of 116 consecutive VATS and RATS lobectomies in the pre-ERAS (Oct 2018–Sep 2019) and ERAS (Oct 2019–Sep 2020) period. Multivariate analysis was used to determine the impact of ERAS and operative approach alone, and in combination, on length of hospital stay (LOS) and overall cost. Operative approach was 49.1% VATS, 50.9% RATS, with 44.8% pre-ERAS, and 55.2% ERAS (median age 68, 65.5% female). ERAS patients had shorter LOS (2.22 vs 3.45 days) and decreased total cost ($15,022 vs $20,155) compared with non-ERAS patients, while RATS was associated with decreased LOS (2.16 vs 4.19 days) and decreased total cost ($14,729 vs $20,484) compared with VATS. The combination of ERAS + RATS showed the shortest LOS and the lowest total cost (1.35 days and $13,588, P < 0.001 vs other combinations). On multivariate analysis, ERAS significantly decreased LOS (P = 0.001) and total cost (P = 0.003) compared with pre-ERAS patients; RATS significantly decreased LOS (P < 0.001) and total cost (P = 0.004) compared with VATS approach. ERAS implementation and robotic approach were independently associated with LOS reduction and cost savings in patients undergoing minimally invasive lobectomy. A combination of ERAS and RATS approach synergistically decreases LOS and overall cost.

Available only for authorised users

Scott WJ et al (2010) Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American college of surgeons oncology group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg 139(4):976–981CrossRefPubMed

Kent M et al (2014) Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg 97(1):236–242CrossRefPubMed

Adams RD et al (2014) Initial multicenter community robotic lobectomy experience: comparisons to a national database. Ann Thorac Surg 97(6):1893–1898CrossRefPubMed

Reddy RM et al (2018) Robotic-assisted versus thoracoscopic lobectomy outcomes from high-volume thoracic surgeons. Ann Thorac Surg 106(3):902–908CrossRefPubMed

Singer E et al (2019) Understanding the financial cost of robotic lobectomy: calculating the value of innovation? Ann Cardiothorac Surg 8(2):194–201CrossRefPubMedPubMedCentral

Jin R et al (2022) Robotic-assisted versus video-assisted thoracoscopic lobectomy: short-term results of a randomized clinical trial (RVlob Trial). Ann Surg 275(2):295–302CrossRefPubMed

Low DE et al (2019) Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS^®) society recommendations. World J Surg 43(2):299–330CrossRefPubMed

Lassen K et al (2012) Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS^®) society recommendations. Clin Nutr 31(6):817–830CrossRefPubMed

Gustafsson UO et al (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS^®) society recommendations: 2018. World J Surg 43(3):659–695CrossRefPubMed

10.

Kowalsky SJ et al (2019) A combination of robotic approach and ERAS pathway optimizes outcomes and cost for pancreatoduodenectomy. Ann Surg 269(6):1138–1145CrossRefPubMed

11.

Nicholson A et al (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101(3):172–188CrossRefPubMed

12.

Li S et al (2017) Enhanced recovery programs in lung cancer surgery: systematic review and meta-analysis of randomized controlled trials. Cancer Manag Res 9:657–670CrossRefPubMedPubMedCentral

13.

Batchelor TJP et al (2019) Guidelines for enhanced recovery after lung surgery: recommendations of the enhanced recovery after surgery (ERAS^®) society and the European society of thoracic surgeons (ESTS). Eur J Cardiothorac Surg 55(1):91–115CrossRefPubMed

14.

Ikeda M et al (2002) Angiographic evaluation of the luminal changes in the radial artery graft in coronary artery bypass surgery: a concern over the long-term patency. Eur J Cardiothorac Surg 21(5):800–803CrossRefPubMed

15.

Veronesi G et al (2016) Robot-assisted surgery for lung cancer: state of the art and perspectives. Lung Cancer 101:28–34CrossRefPubMed

16.

Liang H et al (2018) Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis. Ann Surg 268(2):254–259CrossRefPubMed

17.

Pardolesi A et al (2012) Robotic anatomic segmentectomy of the lung: technical aspects and initial results. Ann Thorac Surg 94(3):929–934CrossRefPubMed

18.

Kneuertz PJ et al (2018) Robotic lobectomy has the greatest benefit in patients with marginal pulmonary function. J Cardiothorac Surg 13(1):56CrossRefPubMedPubMedCentral

19.

Madani A et al (2015) An enhanced recovery pathway reduces duration of stay and complications after open pulmonary lobectomy. Surgery 158(4):899–908CrossRefPubMed

20.

Scarci M, Solli P, Bedetti B (2016) Enhanced recovery pathway for thoracic surgery in the UK. J Thorac Dis 8(Suppl 1):S78-83PubMedPubMedCentral

21.

Rogers LJ et al (2018) The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer. J Thorac Cardiovasc Surg 155(4):1843–1852CrossRefPubMed

22.

Varela G et al (2009) Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg 35(1):28–31CrossRefPubMed

23.

Brunelli A et al (2010) Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial. Eur J Cardiothorac Surg 37(1):56–60CrossRefPubMed

24.

Cerfolio RJ, Bryant AS (2008) The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study. Ann Thorac Surg 86(2):396–401CrossRefPubMed

25.

Martin LW et al (2018) Implementing a thoracic enhanced recovery program: lessons learned in the first year. Ann Thorac Surg 105(6):1597–1604CrossRefPubMed

26.

Brunelli A et al (2017) Enhanced recovery pathway versus standard care in patients undergoing video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg 154(6):2084–2090CrossRefPubMed

27.

Zirafa CC et al (2019) The evolution of robotic thoracic surgery. Ann Cardiothorac Surg 8(2):210–217CrossRefPubMedPubMedCentral

28.

Kent MS et al (2021) Pulmonary open, robotic and thoracoscopic lobectomy (PORTaL) study: an analysis of 5,721 cases. Ann Surg. https://doi.org/10.1097/sla.0000000000005115CrossRefPubMed

29.

Meyer M et al (2012) The learning curve of robotic lobectomy. Int J Med Robot 8(4):448–452CrossRefPubMed

30.

Soomro NA et al (2020) Systematic review of learning curves in robot-assisted surgery. BJS Open 4(1):27–44CrossRefPubMed

Title: The impact of an enhanced recovery after surgery pathway for video-assisted and robotic-assisted lobectomy on surgical outcomes and costs: a retrospective single-center cohort study
Authors: Shiwei Han
Simo Du
Christina Jander
Madhan Kuppusamy
Joel Sternbach
Donald E. Low
Michal Hubka
Publication date: 14-12-2022
Publisher: Springer London
Published in: Journal of Robotic Surgery / Issue 3/2023
Print ISSN: 1863-2483
Electronic ISSN: 1863-2491
DOI: https://doi.org/10.1007/s11701-022-01487-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of an enhanced recovery after surgery pathway for video-assisted and robotic-assisted lobectomy on surgical outcomes and costs: a retrospective single-center cohort study

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2023

A propensity score matching study of totally robotic right hemicolectomy versus robot-assisted right hemicolectomy

Analysis of fixed and variable operating room (or) time point efficiency in partial nephrectomies: open versus robotic-assisted

Preliminary outcomes of kinematically aligned robot-assisted total knee arthroplasty with patient-specific cartilage thickness measurement

Medial versus lateral camera port placement for robotic nephron-sparing surgery: evaluating surgical complications and outcomes

Short-term outcomes of robot-assisted versus conventional laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiotherapy: a propensity score-matched analysis

Systematic review of academic robotic surgery curricula