Influence of conversion on cost of video-assisted thoracoscopic lobectomy
Bibliographic record
Abstract
We would like to congratulate the authors on their detailed cost analysis of VATS lobectomy [1]. Their results and conclusions regarding the differences in intra-operative costs of VATS lobectomy compared to thoracotomy lobectomy and the influence of the length of stay very much mirror our own larger experience in Canada. When we compared costs of over 250 VATS lobectomy cases to an open lobectomy, intra-operative costs were approximately double ($2810CD vs $1425CD). However, length of stay (LOS) was 1.3 days shorter for VATS cases (4.9 days vs 6.2 days). Based on an analysis of overall costs, a VATS lobectomy was equal or slightly less than an open lobectomy ($8573CD vs $8673CD). The similarity between the costs from our experience and that of Mr Walker’s group is striking. An additional influence on intra-operative cost and potential impact on LOS is the need to convert a VATS to an open lobectomy. No mention was made of this, though elsewhere the group has reported conversion rates of around 10% [2]. In our analysis, conversion rates over the 3-year period were 13% (35 cases converted). We have examined the causes of conversion in our unit and proposed a method of auditing this (presented recently as an abstract at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2009 meeting). Clearly, the timing and cause of conversion during surgery will have some influence on the intra-operative costs incurred, but, overall, converting a VATS lobectomy to a thoracotomy had little impact on total intra-operative costs ($2861CD no conversion vs $2569CD converted). The difference between LOS on patients who had been converted was half a day (4.9 days no conversion vs 5.4 days converted). Majority of the patients were converted through an extension of the axillary utility incision with only a few patients requiring a separate posterolateral thoracotomy. This translated into a difference in LOS costs of $610CD ($5669CD no conversion vs $6279CD converted). Overall the difference in costs incurred following conversion was $303CD ($8546CD no conversion vs $8849CD conversion). Conversion through the axillary incision appears to have a small adverse influence on increased LOS and overall impact on cost was low. Our experience will be presented this summer at the 13th World Conference on Lung Cancer, and we welcome Mr Walker’s perspective on the influence of conversion rates on the costs incurred.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.020 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".