CHEST Guidelines-Response_chest

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The document discusses studies on robotic lobectomies in the US, focusing on surgery outcomes in relation to hospital volume. High-volume centers showed shorter hospital stays and lower mortality for robotic lobectomies. However, many surgeries were performed in low-volume centers, which may not provide a full picture of the technology’s potential. Surgeons are recommended to perform about 20 procedures to gain proficiency, but many hospitals don’t meet this threshold.<br /><br />A study by Swanson et al. highlighted that robotic lobectomies were costlier and more time-consuming than video-assisted thoracoscopic surgery without improved outcomes. Despite the advantages in theory, the adoption of robotic technology was slow during the years studied (2008-2013), likely due to high costs and the predominance of hospitals with low surgical volumes.<br /><br />The authors Novellis, Veronesi, and Alloisio suggest that promising outcomes from centers with proficient surgeons should inform technology evaluation. The response from Tchouta et al. recognizes the necessity for further study into learning curves and emphasizes that low-volume centers still represent significant current practice, reflecting newer centers adopting robotic-assisted thoracic surgery (RobATS).<br /><br />They stress the importance of examining outcomes in various contexts and acknowledge low-volume centers’ significance. Future studies on surgical team performance and changing technology adoption are needed to provide a comprehensive understanding of robotic surgery's effectiveness and cost-efficiency, suggesting competitive market entrants may lower costs.<br /><br />Additionally, research on 30-day readmission in adults with COPD or bronchiectasis using the Nationwide Readmissions Database highlights the detailed study of readmissions but notes limitations due to demographic data and predictor identification constraints in existing systems. These findings imply a broader analysis and improved data systems are necessary for robust healthcare decision-making.
Keywords
robotic lobectomies
hospital volume
surgery outcomes
Swanson et al.
costs
learning curves
low-volume centers
technology adoption
30-day readmission
COPD