The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies.

Journal Article (Journal Article)


Video-assisted thoracoscopic surgery (VATS) lobectomy is quickly becoming the standard of care for many patients with early-stage non-small-cell lung cancer (NSCLC) and benign lung conditions. There is a lack of published data defining the differential impact of preoperative patient comorbidity on outcomes following VATS and OPEN lobectomies, which would be beneficial for procedure selection and clinical decision-making.


A retrospective analysis of the 2008-2011 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP) database was performed. Demographic and clinical data on patients ≥18 years having undergone VATS or OPEN lobectomy were included. Measured outcomes included postoperative length of stay (PO-LOS), in-hospital mortality and perioperative pulmonary complications. PO-LOS was further analysed using multivariable logistic regression and cumulative incidence models.


VATS lobectomies were associated with shorter PO-LOS and fewer complications even after censoring for inpatient mortality. Furthermore, VATS lobectomy patients had improved PO-LOS compared with OPEN lobectomy patients, even with greater comorbidity. Logistic regression modelling for PO-LOS ≥14 days identified independent predictors of prolonged PO-LOS, including male gender, non-elective admission, lower hospital lobectomy volume, several Elixhauser comorbidities and performance of OPEN lobectomy.


The expected postoperative length of stay for a patient treated by OPEN lobectomy is approximately equal to that of a VATS lobectomy patient with an additional 2-3 comorbidities. The VATS approach remains advantageous with respect to PO-LOS, regardless of the number of comorbidities.

Full Text

Duke Authors

Cited Authors

  • Jawitz, OK; Wang, Z; Boffa, DJ; Detterbeck, FC; Blasberg, JD; Kim, AW

Published Date

  • January 2017

Published In

Volume / Issue

  • 51 / 1

Start / End Page

  • 169 - 174

PubMed ID

  • 27458143

Electronic International Standard Serial Number (EISSN)

  • 1873-734X

International Standard Serial Number (ISSN)

  • 1010-7940

Digital Object Identifier (DOI)

  • 10.1093/ejcts/ezw239


  • eng