Key result
VATS was associated with a higher probability of high time-at-home at 5 years compared to open surgery (55.6% vs 45.4%; HR 0.81, 95% CI 0.74-0.89; P<0.001).
Why the study?
Although the benefits of VATS for lung cancer resection have been reported, there is a knowledge gap regarding long-term functional outcomes central to decision-making for older adults.
Does VATS reduce long-term healthcare dependency compared to open surgery in older adults undergoing lung cancer resection?
Cohort (n=4,974)
Yes
Does VATS reduce long-term healthcare dependency compared to open surgery in older adults undergoing lung cancer resection?
Hazard Ratio: 0.81 (95% CI 0.74–0.89)
Absolute Event Rate: 55.6% vs 45.4%
p-value: p=<0.001
In older adults undergoing lung cancer resection, VATS is associated with reduced long-term functional dependence and lower homecare needs compared to open surgery.
May support VATS preference for long-term independence; leaves open causal confirmation in randomized trials.
OBJECTIVE: To examine the long-term healthcare dependency outcomes of older adults undergoing VATS compared to open lung cancer resection. SUMMARY OF BACKGROUND DATA: Although the benefits of VATS for lung cancer resection have been reported, there is a knowledge gap related to long-term functional outcomes central to decision-making for older adults. METHODS: We conducted a population-based retrospective comparative cohort study of patients ≥70 years old undergoing lung cancer resection between 2010 and 2017 using linked administrative health databases. VATS was compared to open surgery for lung cancer resection. Outcomes were receipt of homecare and high time-at-home, defined as <14 institution-days within 1 year, in 5 years after surgery. We used time-to-event analyses. Homecare was analyzed as recurrent dichotomous outcome with Andersen-Gill multivariable models, and high time-at-home with Cox multivariable models. RESULTS: Of 4974 patients, 2951 had VATS (59.3%). In the first three months postoperatively, homecare use ranged from 17.5% to 34.4% for VATS and 23.0% to 36.6% for open surgery. VATS was independently associated with lower need for postoperative homecare over 5 years (hazard ratio 0.82, 95% confidence interval 0.74-0.92). 1- and 5-year probability of high "time-at-home" were superior for VATS (74.4% vs 66.7% and 55.6% vs 45.4%, p < 0.001). VATS was independently associated with higher probability of high "time-at-home" (hazard ratio 0.81, 95% confidence interval 0.74-0.89) compared to open surgery. CONCLUSIONS: Compared to open surgery, VATS was associated with lower homecare needs and higher probability of high "time-at-home," indicating reduced long-term functional dependence. Those important patient-centered endpoints reflect the overall long-term treatment burden on mortality and morbidity that can inform surgical decision-making.
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Hallet et al. (2022) conducted a cohort in Lung cancer (n=4,974). Video-assisted thoracoscopic surgery (VATS) vs. Open surgery was evaluated on High time-at-home (<14 institution-days within 1 year) at 5 years (HR 0.81, 95% CI 0.74-0.89, p=<0.001). VATS was associated with a higher probability of high time-at-home at 5 years compared to open surgery (55.6% vs 45.4%; HR 0.81, 95% CI 0.74-0.89; P<0.001).
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