Abstract
Importance: Minimally invasive lobectomy for early-stage lung cancer has become more prevalent. Video-assisted thoracoscopic surgery has lower rates of morbidity, better long-term survival, and equivalent oncologic outcomes compared with thoracotomy. However, little has been published on the use and outcomes of video-assisted thoracoscopic surgery within Veterans Affairs. There is a public assumption that the the Veterans Affairs is slow to adopt new procedures and technologies. Objective: To determine the uptake of video-assisted thoracoscopic surgery within the Veterans Affairs for patients with known or suspected lung cancer. Design, Setting, and Participants: In this retrospective cohort study of national Veterans Affairs Corporate Data Warehouse data from January 2002 to December 2015, a total of 11004 veterans underwent lung resection for known or suspected lung cancer. Data were analyzed from March to November 2018. Exposures: Open or video-assisted thoracoscopic lobectomy or wedge resection. Main Outcomes and Measures: Patient demographic characteristics and procedure and diagnosis International Classification of Diseases, Ninth Revision codes were abstracted from Corporate Data Warehouse data. Results: Of the 11004 included veterans, 10587 (96.2%) were male, and the median (interquartile range) age was 66.0 (61.0-72.0) years. Of 11004 included procedures, 8526 (77.5%) were lobectomies and 2478 (22.5%) were wedge resections. The proportion of video-assisted thoracoscopic lung resections increased steadily from 15.6% in 2002 to 50.6% in 2015. Video-assisted thoracoscopic surgery use by Veterans Integrated Service Networks ranged from 0% to 81.7%, and higher Veterans Integrated Service Network volume was correlated with higher video-assisted thoracoscopic surgery use (Pearson r = 0.35; 95% CI, 0.15-0.52; P <.001). Video-assisted thoracoscopic surgery use and rate of uptake varied widely across Veteran Affairs regions (P <.001 by Wilcoxon signed rank test). Conclusions and Relevance: Paralleling academic hospitals, most lung resections are now performed in the Veterans Affairs using video-assisted thoracoscopic surgery. More research is needed to identify reasons behind the heterogeneous uptake of video-assisted thoracoscopic surgery across Veterans Affairs regions.. © 2019 American Medical Association. All rights reserved.