Martin A Martino1, Elizabeth A Berger2, Jeffrey T McFetridge3, Jocelyn Shubella4, Gabrielle Gosciniak5, Taylor Wejkszner6, Gregory F Kainz2, Jeremy Patriarco4, M Bijoy Thomas4, Richard Boulay4. 1. Division of Gynecologic Oncology, Lehigh Valley Health Network, Lehigh Valley Health Network, Allentown, Pennsylvania. Electronic address: martin_a.martino@lvhn.org. 2. Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania. 3. Lehigh University, Bethlehem, Pennsylvania. 4. Division of Gynecologic Oncology, Lehigh Valley Health Network, Lehigh Valley Health Network, Allentown, Pennsylvania. 5. University of Pennsylvania. 6. Rollins College, Winter Park, Florida.
Abstract
STUDY OBJECTIVE: To measure procedure-related hospital readmissions within 30 days after discharge for patients who have a hysterectomy for benign disease. Secondary outcome quality measures evaluated were cost, estimated blood loss, length of stay and sum of costs associated with readmissions. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Academic community hospital. PATIENTS: Patients who underwent hysterectomy to treat benign disease from January 2008 to December 2012. INTERVENTIONS: Patients were grouped according to route of hysterectomy: robotic-assisted laparoscopic hysterectomy (robotic), laparoscopic hysterectomy (laparoscopic), abdominal hysterectomy (open via laparotomy), and vaginal hysterectomy (vaginal). MEASUREMENTS AND MAIN RESULTS: Inclusion criteria were met by 2554 patients: 601 in the robotic group, 427 in the laparoscopic group, 1194 in the abdominal group, and 332 in the vaginal group. Readmission rates in the robotic cohort were significantly less (p<.05) than in non-robotic cohorts: Robotic (1%), laparoscopic (2.5%), open (3.5%), vaginal (2.4%). Estimated blood loss, length of stay, and sum of readmission costs were also significantly less in the robotic cohort (p<.05) compared with the other 3 cohorts. CONCLUSION: Patients who undergo robotic-assisted laparoscopic hysterectomy have a significantly lower chance of readmission <30 days after surgery compared with those who undergo laparoscopic, abdominal (open) hysterectomy, and vaginal approaches. Patients in the robotics cohort also experienced a shorter length of stay, less estimated blood loss, and a cost savings associated with readmissions when compared to non-robotic approaches. Prospective registries describing quality outcomes, total sum of costs including 30 days follow-up, as well as patient-related quality of life benefits are recommended to confirm these findings and determine which surgical route offers the highest patient and societal value.
STUDY OBJECTIVE: To measure procedure-related hospital readmissions within 30 days after discharge for patients who have a hysterectomy for benign disease. Secondary outcome quality measures evaluated were cost, estimated blood loss, length of stay and sum of costs associated with readmissions. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Academic community hospital. PATIENTS: Patients who underwent hysterectomy to treat benign disease from January 2008 to December 2012. INTERVENTIONS:Patients were grouped according to route of hysterectomy: robotic-assisted laparoscopic hysterectomy (robotic), laparoscopic hysterectomy (laparoscopic), abdominal hysterectomy (open via laparotomy), and vaginal hysterectomy (vaginal). MEASUREMENTS AND MAIN RESULTS: Inclusion criteria were met by 2554 patients: 601 in the robotic group, 427 in the laparoscopic group, 1194 in the abdominal group, and 332 in the vaginal group. Readmission rates in the robotic cohort were significantly less (p<.05) than in non-robotic cohorts: Robotic (1%), laparoscopic (2.5%), open (3.5%), vaginal (2.4%). Estimated blood loss, length of stay, and sum of readmission costs were also significantly less in the robotic cohort (p<.05) compared with the other 3 cohorts. CONCLUSION:Patients who undergo robotic-assisted laparoscopic hysterectomy have a significantly lower chance of readmission <30 days after surgery compared with those who undergo laparoscopic, abdominal (open) hysterectomy, and vaginal approaches. Patients in the robotics cohort also experienced a shorter length of stay, less estimated blood loss, and a cost savings associated with readmissions when compared to non-robotic approaches. Prospective registries describing quality outcomes, total sum of costs including 30 days follow-up, as well as patient-related quality of life benefits are recommended to confirm these findings and determine which surgical route offers the highest patient and societal value.
Authors: Benjamin B Albright; Tilman Witte; Alena N Tofte; Jeremy Chou; Jonathan D Black; Vrunda B Desai; Elisabeth A Erekson Journal: J Minim Invasive Gynecol Date: 2015-08-10 Impact factor: 4.137
Authors: Gaby N Moawad; Elias D Abi Khalil; Paul Tyan; Michael K Shu; David Samuel; Richard Amdur; Stacey A Scheib; Cherie Q Marfori Journal: J Robot Surg Date: 2017-01-31
Authors: Ha Na Yoo; Tae Joong Kim; Yoo Young Lee; Chel Hun Choi; Jeong Won Lee; Duk Soo Bae; Byoung Gie Kim Journal: J Gynecol Oncol Date: 2015-01 Impact factor: 4.401