“Trimming the VAT(S)”: maximizing value delivery in thoracoscopic lobectomy—a narrative review

Abstract

Background and Objective: Increased financial strain on health care systems has accelerated attention on reducing health care costs without compromising quality of care. The rapid adoption of video-assisted thoracic surgery (VATS) over the past decade has led to surging operative costs. A review of cost-minimization strategies specific to VATS lobectomy procedures would serve as a useful resource for implementing value-based care in thoracic surgical practice. Methods: A literature review was carried out using MEDLINE, PubMed, Scopus, Google Scholar, and Cochrane databases between January 1990 and November 2022 to identify all studies on cost reduction in VATS lobectomy, using major search terms “VATS”, “VATS lobectomy”, “thoracoscopy” or “thoracoscopic lobectomy” and “cost”. Studies involving benign diseases were excluded. Also removed were comparison studies of VATS vs. other surgical approaches i.e., uniportal, open thoracotomy or robotic pulmonary resections. Key Content and Findings: Principles of value delivery for VATS lobectomy derived from the literature were reviewed and central themes identified, including avoidance of perioperative complications, cost awareness, value stream mapping/standardization, evidence-based value delivery and performance feedback/ peer comparison. Successful cost reduction strategies routinely utilized central principles of behavioral economics. Conclusions: A variety of value improvement initiatives have been demonstrated to reduce costs related to VATS lobectomy without compromising quality. It is important for surgeons to take the lead in maximizing value delivery to guide changes that optimize cost efficiency without compromising surgical care.