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Five Years of Video Assisted Thoracoscopic Surgery (VATS) at an Academic Institution: a Retrospective Review of Cost and Complications
*Sarah Lomas, Bruce J Leavitt, Mitchell C. Norotsky
Fletcher Allen Health Care, University of Vermont, Burlington, VT

We reviewed the cost of performing VATS at our institution and the additional cost associated with complications.
IRB-approved, retrospective chart review for VATS performed over five years
562-bed academic medical center, serving one million patients in New England
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
DiagnosisNumber of Patients
interstitial lung disease83
malignant and benign pleural effusions69
malignant and benign tumors35

Main Outcome Measures:
Total cost
American Society of Anesthesiologists (ASA) rating
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.
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.

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