Impact of Geographic and Sociodemographic Factors on the Utilization of Robotic Lung Resection versus Videoscopic Lung Resection

 

Aaron R. Dezube MD 1,2, Natasha K Valas DO 1,2, Michael Dezube M.Eng 3, Virginia R. Litle MD 1,2

1. St. Elizabeth’s Medical Center, Brighton, MA; 2. Boston University Chobanian and Avedisian School of Medicine, Boston, MA; 3. Department of Radiology, Massachusetts General Hospital, Boston MA

Background

• Robotic-assisted thoracoscopic surgery

(RATS) is now a widely accepted

approach for lung resection.

• Less is know about patterns of usage

within the United States.

Investigate whether geographic and

sociodemographic factors impact trends

in utilization of RATS versus video-assisted

thoracoscopic surgery (VATS) for lung

resection in the United States.

 

A data use agreement was signed.

• All patients with complete demographic

variables undergoing RATS and VATS

within the National Inpatient Sample

between 2016-2020 for benign or

malignant neoplasms and nodules were

included.

• Degree of resection and technique were

compared with respect to pretreatment

variables: sociodemographic, hospital

81,360 patients underwent lobectomy

(35.7% vs. 64.3% for RATS and VATS

respectively).

• 88,620 underwent sub-lobar resection

(24.2% vs 75.8% for RATS and VATS

respectively).

• Rates of RATS lung resection increased

annually

• Rate varied by geographic hospital

division (Figure 1 + 2)

• Differences in sociodemographic,

hospital-level, and geographic variables

were present between the RATS and

VATS cohorts (all p<0.05).

• Odds of RATS utilization for lobectomy

varied by geographic hospital division

(Table 1) as well as patient and hospital

factors.

• Odds of RATS utilization for sublobar

resection varied by geographic hospital

division.

• Odds of RATS utilization for

sublobar resection was not

significant for insurance status

 

There were significant geographic differences

in RATS utilization over VATS for lung

resection.

• Demographic and hospital level factors also

impacted odds of RATS utilization.

• Rurarlness impacted odds, but poverty

and payer type largely did not for either

lobectomy or sublobar resection

• Overall rates of RATS utilization between

different geographic ranged from 16.9% to

44.7% for lobectomy and 11.5% to 30.6% for

sublobar lung resection