Long-term functional outcomes among older adults undergoing video-assisted versus open surgery for lung cancer: a population-based cohort study

Objective — To examine the long-term healthcare dependency outcomes of older adults undergoing video-assisted thoracic surgery (VATS) compared to open lung cancer resection.

Summary Background Data — While the benefits of video-assisted thoracoscopic surgery (VATS) for lung cancer resection have been reported, there is a knowledge gap related to long-term functional outcomes central to decision-making for older adults.

Methods — We conducted a population-based retrospective comparative cohort study of patients > 70 years old undergoing lung cancer resection between 2010-2017 using linked administrative health databases. VATS was compared to open surgery for lung cancer resection. Outcomes were receipt of homecare and high time-at-home, defined as <14 institution-days within one year, in 5 years after surgery. We used time-to-event analyses. Homecare was analyzed as recurrent dichotomous outcome with Andersen-Gill multivariable models, and high time-at-home with Cox multivariable models.

Results — Of 4,974 patients, 2,951 had VATS (59.3%). In the first three months postoperatively, homecare use ranged from 17.5-34.4% for VATS and 23.0-36.6% for open surgery. VATS was independently associated with lower need for postoperative homecare over 5 years (hazard ratio – H R 0.82, 95%CI 0.74-0.92). 1- and 5-year probability of high "time-at-home" were superior for VATS (74.4% vs. 66.7% and 55.6% vs. 45.4%, p<0.001). VATS was independently associated with higher probability of high "time-at-home" (HR 0.81, 95%CI 0.74-0.89) compared to open surgery.

Conclusions — Compared to open surgery, VATS was associated with lower homecare needs and higher probability of high "time-at-home", indicating reduced long-term functional dependence. Those important patient-centred endpoints reflect the overall long-term treatment burden on mortality and morbidity that can inform surgical decision-making.