Increased Adoption of Robotic Lobectomy and Improved Outcomes: Evidence from the Nationwide Readmission Database

Background: Analysis of the Nationwide Readmission Database from 2010 to 2014 showed a clear benefit of a minimally invasive approach to pulmonary lobectomy. We aimed to determine whether the adoption of minimally invasive surgical technology has increased since then. Methods: We performed a retrospective cohort analysis of the Nationwide Readmission Database data from 2016 to 2018. We compared the readmission rates and mortality between open lobectomy, video-assisted thoracoscopic surgery (VATS), and robotic lobectomy. We then performed a multivariate analysis of the factors associated with readmission and mortality. Results: A total of 62,020 lobectomies were identified, including 43.2% open, 40.0% VATS, and 16.8% robotic. There was a significant increase in minimally invasive procedures over the time period, driven by a tripling of robotic cases compared with 2010-2014 (P < .001). VATS and robotic approaches had significantly lower readmission (open 9.3%, VATS 7.1%, robotic 6.8%; P < .001) and mortality rates (open 2.7%, VATS 0.7%, robotic 0.5%; P < .001). Multivariate analysis showed that VATS (P < .001) and robotic lobectomy (P < .001) were independent factors associated with lower readmission and mortality rates. Conclusions: There has been a shift from open to minimally invasive lobectomy due to the increased adoption of robotic technology, resulting in significant improvements in hospital readmission rates and mortality. Further adoption of minimally invasive platforms may improve outcomes after pulmonary lobectomies.