Background Video-assisted thoracoscopic surgery (VATS) offers reduced morbidity compared with open thoracotomy (OT) for pulmonary surgery. The use of VATS over time has increased, but at a modest rate in civilian populations. This study examines temporal trends in VATS use and compares outcomes between VATS and OT in the Veterans Health Administration (VHA).

Methods Patients who underwent pulmonary surgery (wedge or segmental resection, lobectomy, or pneumonectomy) at Veterans Affairs centers from 2008 to 2018 were retrospectively identified using the Veterans Affairs Surgical Quality Improvement Project database. The cohort was divided into OT and VATS and propensity score matched, taking into account the type of pulmonary resection, preoperative diagnosis, and comorbidities. Thirty-day postoperative outcomes were compared. The prevalence of VATS use and respective complications over time was also analyzed.

Results A total of 16,895 patients were identified, with 5,748 per group after propensity matching. VATS had significantly lower rates of morbidity and a 2-day reduction in hospital stay. Whereas 76% of lung resections were performed open in 2008, nearly 70% of procedures were performed using VATS in 2018. While VATS was associated with an 8% lower rate of major complications compared with thoracotomy in 2008, patients undergoing VATS lung resection in 2018 had a 58% lower rate of complications (p < 0.001).

Conclusions VATS utilization at VHA centers has become the predominant technique used for pulmonary surgeries over time. OT patients had more complications and longer hospital stays compared with VATS. Over the study period, VATS patients had increasingly lower complication rates compared with open surgery.

背景 与开胸手术 (OT) 相比，电视胸腔镜手术 (VATS) 可降低肺部手术的发病率。随着时间的推移，VATS 的使用有所增加，但在平民中的使用率适中。本研究检查了 VATS 使用的时间趋势，并比较了退伍军人健康管理局 (VHA) 中 VATS 和 OT 之间的结果。

方法 使用退伍军人事务手术质量改进项目数据库回顾性确定 2008 年至 2018 年在退伍军人事务中心接受肺手术（楔形或节段切除术、肺叶切除术或全肺切除术）的患者。考虑到肺切除的类型、术前诊断和合并症，将队列分为 OT 和 VATS，倾向评分匹配。比较了术后 30 天的结果。随着时间的推移，还分析了 VATS 的使用率和相应的并发症。

结果 共识别出16895例患者，倾向匹配后每组5748例。VATS 的发病率显着降低，住院时间缩短了 2 天。2008 年 76% 的肺切除术是开放式进行的，而 2018 年近 70% 的手术是使用 VATS 进行的。虽然与 2008 年的开胸手术相比，VATS 的主要并发症发生率降低了 8%，但 2018 年接受 VATS 肺切除术的患者并发症发生率降低 58% ( p  < 0.001)。

结论 随着时间的推移，VHA 中心的 VATS 使用已成为肺部手术的主要技术。与 VATS 相比，OT 患者的并发症更多，住院时间更长。在研究期间，与开放手术相比，VATS 患者的并发症发生率越来越低。