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Objective:
We reviewed the cost of performing VATS at our institution and the additional cost associated with complications.
Design:
IRB-approved, retrospective chart review for VATS performed over five years
Setting:
562-bed academic medical center, serving one million patients in New England
Patients:
Over the past five years, 319 patients underwent VATS (Table 1). The patients' ages ranged from 1.5 to 88 years, with the mean age being 50.4 ± 20 years. About 55% of the patients were male.

Table 1

Diagnosis	Number of Patients
pneumothorax/hemothorax	87
interstitial lung disease	83
malignant and benign pleural effusions	69
malignant and benign tumors	35
empyema	22
hyperhidrosis	12
other	11

Main Outcome Measures:
Complications
Total cost
American Society of Anesthesiologists (ASA) rating
Results:
Of the 319 patients identified, 24 suffered complications, the most common being prolonged air leak (n=11). The median total cost for patients without complications was $9,544, whereas the median total cost for patients with complications was 60% higher at $15,283 (Wilcoxon rank-sum test, p=0.002). There were no significant differences between ASA rating or age and presence of complications.
Conclusions:
Howington et. al. found that VATS resulted in decreased operative times and hospital costs, and that the average cost of a VATS was $14,795 ± $4,415, which is similar to the range we found at our institution. We have shown how the added expense of a complication drives the cost toward the higher end of that range. As payments shift away from fee-for-service to flat fees based on admission diagnosis or procedure performed, the presence of a complication detracts from the bottom line. It is our duty to deliver quality care in the most cost effective manner possible.