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. 2021 Nov;12(22):2981-2989.
doi: 10.1111/1759-7714.14161. Epub 2021 Sep 28.

Escalated grades of complications correlate with incremental costs of video-assisted thoracoscopic surgery major lung resection for lung cancer in China

Ke Lan  1 , Jian Zhou  1 , Xizhao Sui  1 , Jun Wang  1 , Fan Yang  1
Affiliations

Escalated grades of complications correlate with incremental costs of video-assisted thoracoscopic surgery major lung resection for lung cancer in China

Ke Lan et al. Thorac Cancer. 2021 Nov.

Abstract

Objective: Few studies have focused on factors associated with the incremental cost of video-assisted thoracoscopic surgery (VATS) in China. We aim to systematically classify the complications after VATS major lung resection and explore their correlation with hospital costs.

Methods: Patients with pathologically stage I-III lung cancer who underwent VATS major lung resections from January 2007 to December 2018 were included. The Thoracic Mortality and Morbidity (TM&M) Classification system was used to evaluate postoperative complications. Grade I and II complications, defined as minor complications, require no therapy or pharmacologic intervention only. Grade III and IV complications, defined as major complications, require surgical intervention or life support. Grade V results in death. A generalized linear model was used to explore the correlation of incremental hospital costs and complications, as well as other clinicopathologic parameters between 2013 and 2016.

Results: A total of 2881 patients were enrolled in the first part, and the minor and major complications rates were 24.3% (703 patients) and 8.3% (228 patients), respectively. Six hundred and eighty-two patients were enrolled in the second part. The complications grade II (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.05-1.2, p = 0.0005), grade III (OR 1.55, 95% CI 1.26-1.9, p < 0.0001), grades IV and V (OR 1.09, 95% CI 1.04-1.13, p = 0.0002), diffusion capacity of carbon dioxide (OR 0.998, 95% CI 0.997-1.000, p = 0.004), and duration of chest drainage (OR 1.03, 95% CI 1.02-1.04, p < 0.001) and were independent risk factors for the increase in in-hospital costs of VATS major lung resections.

Conclusions: The severity of complications graded by the TM&M system was an independent risk factor for increased in-hospital costs.

Keywords: complications; cost; lung cancer; video-assisted thoracoscopy surgery.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
Flow diagram documenting the recruitment of patients with lung cancer
FIGURE 2
FIGURE 2
Incidence number and rate of different systems: (a) pulmonary complications, (b) pleural complications,(c) cardiovascular system complications, and (d) other system complications
FIGURE 3
FIGURE 3
Boxplot of in‐hospital costs after video‐assisted thoracoscopic surgery major lung resection by thoracic morbidity and mortality grades
See this image and copyright information in PMC

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