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World Journal of Surgery

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01-09-2016 | Original Scientific Report

Vats Versus Axillary Minithoracotomy in the Management of the Second Episode of Spontaneous Pneumothorax: Cost–Benefit Analysis

Authors: Duilio Divisi, Gabriella Di Leonardo, Roberto Crisci

Published in: World Journal of Surgery | Issue 9/2016

Abstract

Background

Video-assisted thoracic surgery (VATS) was considered the gold standard approach in recurrent spontaneous pneumothorax, with unanimous consensus of opinions. The cost-effectiveness analysis in the surgical treatment of recurrence of primary spontaneous pneumothorax (PSP) was carried out comparing VATS with muscle-sparing axillary minithoracotomy (MSAM).

Methods

Between July 2006 and October 2012 we treated 56 patients with a second episode of PSP by VATS or open approach. Time of intervention, prolonged air leaks, duration of pleural drainage, length of hospitalization, and long-term morbidity were evaluated, establishing the relationship between costs and quality-adjusted life for each technique.

Results

The assessment of pain and threshold of tenderness was more favorable in VATS in respect to MSAM during the 5 years of follow-up (p = 0.004 and <0.001 at 1st year; p = 0.006 and <0.002 at 5th year). The minimally invasive method was less expensive than axillary minithoracotomy (2443.44 € vs. 3170.80 €). The quality-adjusted life expectancy of VATS was better than that of MSAM (57.00 vs. 49.2 at 60 months) as well as the quality-adjusted life year (0.03 at 1st year and 0.13 at 5th year). Incremental cost per life year gained of VATS versus MSAM was between 24,245.33 € (1st year) and 5776.31 € (5th year), making it advantageous at 3rd, 4th, and 5th years.

Conclusions

VATS compared to MSAM in the treatment of a second episode of PSP ensured undoubted clinical advantages associated with significant cost savings.

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Title: Vats Versus Axillary Minithoracotomy in the Management of the Second Episode of Spontaneous Pneumothorax: Cost–Benefit Analysis
Authors: Duilio Divisi
Gabriella Di Leonardo
Roberto Crisci
Publication date: 01-09-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 9/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3558-2

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Vats Versus Axillary Minithoracotomy in the Management of the Second Episode of Spontaneous Pneumothorax: Cost–Benefit Analysis

Abstract

Background

Methods

Results

Conclusions

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Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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