Key result
The combination of an ERAS pathway and robotic-assisted lobectomy synergistically reduced median length of hospital stay to 1.35 days and significantly decreased overall costs compared to pre-ERAS VATS.
Why the study?
The impact of enhanced recovery after surgery pathway implementation on outcomes and cost of robotic- and video-assisted thoracoscopic lobectomy was undetermined.
Does the implementation of an ERAS pathway and robotic approach reduce length of stay and costs in patients undergoing minimally invasive lobectomy?
Cohort (n=116)
No
Does the implementation of an ERAS pathway and robotic approach reduce length of stay and costs in patients undergoing minimally invasive lobectomy?
Mean Difference: -4.06 (95% CI -5.94–-2.18)
Absolute Event Rate: 1.35% vs 4.34%
p-value: p=<0.001
The combination of an ERAS pathway and robotic-assisted approach synergistically reduces length of hospital stay and overall costs for patients undergoing minimally invasive lobectomy.
Supports combined ERAS-robotic lobectomy for shorter stays and lower costs; hypothesis-generating pending RCTs.
Objective 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. Methods 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. Results 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. Conclusion 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 decrease LOS and overall cost.
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Han et al. (2022) conducted a cohort in Minimally invasive lobectomy (n=116). Enhanced Recovery After Surgery (ERAS) pathway and Robotic-Assisted Thoracoscopic Surgery (RATS) vs. Pre-ERAS and Video-Assisted Thoracoscopic Surgery (VATS) was evaluated on Length of hospital stay (days) (MD -4.06, 95% CI -5.94 to -2.18, p=<0.001). The combination of an ERAS pathway and robotic-assisted lobectomy synergistically reduced median length of hospital stay to 1.35 days and significantly decreased overall costs compared to pre-ERAS VATS.
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