Metric Category: Appropriateness
The percentage of all lung and thymus resection procedures performed that were minimally invasive.
Minimally Invasive surgery (MIS) is a safe and effective option for lung and thymus surgery. Minimally invasive lobectomy and thymectomy procedures performed through a video-assisted thoracoscopic surgical approach are associated with fewer postoperative complications and a shorter length of stay compared to open resection. Current literature suggests minimally invasive surgical procedures are associated with lower costs, a shorter hospital stay, reduced opiate use, and an overall shorter recovery.
Applicable to EHR Data?
Requires Pharmacy Data?
The number of procedures from the denominator that were minimally invasive lung resection procedures (CPT codes: 32663, 32664, 32666, 32667, 32668, 32669, 32670, 32671, 32672) or minimally invasive thymus resection procedures (CPT codes: 32673)
The number of all lung resection procedures (CPT codes: 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32491, 32503, 32504, 32505, 32506, 32507, 32608, 32663, 32666, 32667, 32668, 32669, 32670, 32671) or thymus resection procedures (CPT codes: 60521, 60522, 32673) by a given physician during the study period.
All patients who underwent a lung or thymus resection procedure.
If a look back period of data is available prior to the study period, exclude patients who had any history of a lung resection (CPT codes: 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32491, 32503, 32504, 32505, 32506, 32507, 32608, 32663, 32664, 32666, 32667, 32668, 32669, 32670, 32671, 32672), or thymus resection procedure (CPT codes: 60521, 60522, 32673) in the 2 years prior to surgical resection
The surgeon performing the procedure.
GAM establishes clinical thresholds using the input of key physician leaders within a specialty and the GAM clinical team. GAM utilizes an elaborate consensus building process with final adjudication by our leadership team.
|Cases||Pattern of Concern||Outlier|
1. Bendixen M, Kronborg C, Jørgensen OD, Andersen C, Licht PB. Cost-utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial. Eur J Cardiothorac Surg. 2019;56(4):754-761. doi: 10.1093/ejcts/ezz064.
Describes six-year study which evaluated the cost-effectiveness of minimally invasive video-assisted thoracic surgery (VATS) versus thoracotomy for lobectomy and concluded that VATS was more cost effective overall.
2. Long H, Tan Q, Luo Q, et al. Thoracoscopic surgery versus thoracotomy for lung cancer: short-term outcomes of a randomized trial. Ann Thorac Surg. 2018;105(2):386-392. doi: 10.1016/j.athoracsur.2017.08.045.
Details a six-year study which aimed to assess safety and efficacy of video-assisted thoracic surgery (VATS) versus axillary thoracotomy for lobectomy for early-stage non-small lung cancer. The study demonstrated VATS was equally safe and reliable as thoracotomy and potentially superior for operation time and intraoperative blood loss.
3. Cooper MA, Segev DL, Makary MA. Hospital level under-utilization of minimally invasive surgery in the United States: retrospective review. BMJ. 2014;349:g4198. doi: https://doi.org/10.1136/bmj.g4198.
Authors evaluate US hospital utilization of minimally invasive surgical approach for appendectomy, colectomy, total abdominal hysterectomy, and lung lobectomy.
4. Friedant AJ, Handorf EA, Su S, Scott WJ. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol. 2016;11(1):30-8. doi: 10.1016/j.jtho.2015.08.004.
Authors performed systematic review and meta-analysis of 19 years of studies to evaluate minimally invasive versus open thymectomy for thymic malignancies and found that, for selective patients, minimally invasive thymectomy was safe and achieved similar oncologic outcomes to open thymectomy.
5. Boffa DJ, Kosinski AS, Furnary AP, et al. Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy. J Clin Oncolo. 2018; 36(23):2378-2385. doi: 10.1200/JCO.2018.77.8977.
Publication details retrospective study of more than ten thousand patients over age 65 years who underwent lobectomy for stage I lung cancer between 2002 and 2013 and concluded that long-term efficacy of lobectomy performed by video-assisted thoracic surgery (VATS) were noninferior to thoracotomy.
6. Manerikar A, Querrey M, Cerier E, et al. Comparative effectiveness of surgical approaches for lung cancer. Journal of Surgical Research. 2021;263:274-284. https://doi.org/10.1016/j.jss.2020.10.020.
Authors describe their meta-analysis to evaluate minimally invasive techniques, including video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS), compared to open thoracotomy for non-small cell lung cancer and found minimally invasive approaches may be superior in near-term mortality and no difference in long-term outcomes.
7. Hurd J, Haridas C, Potter A, et al. A national analysis of open versus minimally invasive thymectomy for stage I-III thymic carcinoma. Eur J Cardiothorac Surg. 2022;62(3):ezac159. doi:10.1093/ejcts/ezac159
In this national analysis, the authors compared overall survival and short-term outcomes between open and minimally invasive surgery for thymic carcinoma. Minimally invasive thymectomy for stage I-III thymic carcinoma was found to have no significant differences in short-term outcomes and overall survival when compared to open thymectomy.