Wang Jingyan, Zhou Yanran, Jiang Zongming, Yi Shenghua, Wang Yulong
Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China.
Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2024 Oct 31;16(10):6888-6898. doi: 10.21037/jtd-24-869. Epub 2024 Oct 11.
Video-assisted thoracoscopic surgery (VATS) is known to have the advantages of being minimally invasive, reducing complications, and shortening hospitalization time. However, related cost surveys have been inconsistent. In recent years, a new concept of tubeless anesthesia has been introduced, but its impact on the cost-effectiveness of VATS is unclear. This study compared the hospitalization costs and postoperative outcomes in patients undergoing spontaneous ventilation VATS (SV-VATS) and mechanical ventilation VATS (MV-VATS).
We retrospectively analyzed data on the VATS procedures performed at the Shaoxing People's Hospital from June 2022 to July 2023. Overall, 386 patients who met the inclusion criteria were treated with SV-VATS (n=57) or MV-VATS (n=329). Comprehensive cost comparisons were performed between the groups.
The two groups shared comparable clinical characteristics, such as age (P=0.64), sex (P=0.72), body mass index (BMI) (P=0.68), and type of procedure (P=0.43). All costs are expressed in U.S. dollars ($). The overall, diagnostic, operation, and material costs of SV-VATS and MV-VATS were $3,858.71±$746.32 $3,870.26±$990.69 (P=0.94), $911.83 $908.73 (P=0.51), $875.58 $875.58 (P=0.51), and $1,560.5 $1,596.91±$727.18 (P=0.31), respectively. In addition, the median costs of anesthesia materials and total medications were $233.51 $324.02 and $290.63 $364.14, respectively (P<0.001). Among medications, the cost of anesthesia medicine was $179.6±$45.48 $224.12±$54.67, respectively (P<0.001). Postoperative complications, including sore throat, hoarseness, and expectoration, did not occur in the SV-VATS group, whereas 13, 11, and 10 cases were noted, respectively, in the MV-VATS group (13.5%, 11.5%, and 10.4%, respectively; P=0.01, P=0.03, P=0.041). The time to extubation in the SV-VATS and MV-VATS groups was 4 and 10 min, respectively (P<0.001). No intermediate surgery was performed in either group.
Compared with SV-VATS, MV-VATS can reduce patients' anesthesia and medicine costs and has similar postoperative adverse event rates in VATS patients, which is conducive to accelerating patient recovery. Therefore, tubeless anesthesia is recommended for future VATS.
电视辅助胸腔镜手术（VATS）具有微创、减少并发症和缩短住院时间等优点。然而，相关成本调查结果并不一致。近年来，一种新的无管麻醉概念被引入，但它对VATS成本效益的影响尚不清楚。本研究比较了接受自主通气VATS（SV-VATS）和机械通气VATS（MV-VATS）患者的住院费用和术后结果。
我们回顾性分析了2022年6月至2023年7月在绍兴市人民医院进行的VATS手术数据。总体而言，386例符合纳入标准的患者接受了SV-VATS（n = 57）或MV-VATS（n = 329）治疗。对两组进行了综合成本比较。
两组在年龄（P = 0.64）、性别（P = 0.72）、体重指数（BMI）（P = 0.68）和手术类型（P = 0.43）等临床特征方面具有可比性。所有成本均以美元（$）表示。SV-VATS和MV-VATS的总体、诊断、手术和材料成本分别为3,858.71±746.32美元、3,870.26±990.69美元（P = 0.94），911.83美元、908.73美元（P = 0.51），875.58美元、875.58美元（P = 0.51）和1,560.5美元、1,596.91±727.18美元（P = 0.31）。此外，麻醉材料和总药物的中位成本分别为233.51美元与324.02美元以及290.63美元与364.14美元（P < 0.001）。在药物方面，麻醉药物成本分别为179.6±45.48美元与224.12±54.67美元（P < 0.001）。SV-VATS组未发生包括喉咙痛、声音嘶哑和咳痰在内的术后并发症，而MV-VATS组分别有13例、11例和10例（分别为13.5%、11.5%和10.4%；P = 0.01，P = 0.03，P = 0.041）。SV-VATS组和MV-VATS组的拔管时间分别为4分钟和10分钟（P < 0.001）。两组均未进行中转手术。
与SV-VATS相比，MV-VATS可降低患者的麻醉和药物成本，且VATS患者术后不良事件发生率相似，有利于加速患者康复。因此，建议未来VATS采用无管麻醉。
