To Be or Not To Be: Technical and Cost Implications of Having a Confirmed Diagnosis of Lung Cancer (or not) Before Surgery

Abstract Objective: To compare the costs and length of hospital stay between patients with a confirmed lung cancer (LC) diagnosis before surgery versus those without confirmed diagnosis. Methods: Retrospective and single center study conducted on consecutive patients who underwent a LC surgical procedure, with or without a pathologically confirmed LC diagnosis before surgery, between March 2017 and December 2019. The main outcomes were costs and length of hospital stay (LOHS). Results: Among the 269 screened patients, 254 met the inclusion/exclusion criteria and were included in the analysis, 196 (77.2%) with confirmed LC diagnosis before surgery and 58 (22.8%) without it. Unadjusted cost was significantly lower in patients who underwent surgery without histopathological diagnosis before surgery than in those who underwent surgery with a histopathological diagnosis before surgery (Hodges-Lehmann median difference: -1,280.5 €; 95% confidence interval [CI]: -1,682.1 to -899.4 €, p<0.0001). LOHS was significantly shorter in patients without a previous diagnosis of LC before surgery (4.0 [95%CI: 3.0 - 4.0] vs. 5.0 [95% CI: 5.0 - 6.0] days, p<0.0001). Median (95% CI) LOHS was significantly lower in patients who underwent video-assisted thoracoscopy (4.0 [95% CI 4.0 -4.0] days) than in those who underwent open-surgery (6.0 [95% CI 5.0 - 6.0] days, p<0.0001). Conclusions: Patients who went into the operating-room without a previous confirmed diagnosis of LC resulted in lower direct costs, shorter LOHS, and increased use of VATS.