John K Chan1, Austin B Gardner2, Katie Taylor3, Caroline A Thompson4, Kevin Blansit2, Xinhua Yu5, Daniel S Kapp6. 1. Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, United States. Electronic address: chanjohn@sutterhealth.org. 2. Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States. 3. Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, United States. 4. Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States; Department of Epidemiology and Biostatistics, College of Public Health, San Diego State University, San Diego, CA, United States. 5. Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States. 6. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States.
Abstract
OBJECTIVE: To compare the complications and charges of robotic vs. laparoscopic vs. open surgeries in morbidly obese patients treated for endometrial cancer. METHODS: Data were obtained from the Nationwide Inpatient Sample from 2011. Chi-squared, Wilcoxon rank sum two-sample tests, and multivariate analyses were used for statistical analyses. RESULTS: Of 1087 morbidly obese (BMI ≥40kg/m(2)) endometrial cancer patients (median age: 59years, range: 22 to 89), 567 (52%) had open surgery (OS), 98 (9%) laparoscopic (LS), and 422 (39%) robotic surgery (RS). 23% of OS, 13% of LS, and 8% of RS patients experienced an intraoperative or postoperative complication including: blood transfusions, mechanical ventilation, urinary tract injury, gastrointestinal injury, wound debridement, infection, venous thromboembolism, and lymphedema (p<0.0001). RS and LS patients were less likely to receive blood transfusions compared to OS (5% and 6% vs. 14%, respectively; p<0.0001). The median lengths of hospitalization for OS, LS, and RS patients were 4, 1, and 1days, respectively (p<0.0001). Median total charges associated with OS, LS, and RS were $39,281, $40,997, and $45,030 (p=0.037), respectively. CONCLUSIONS: In morbidly obese endometrial cancer patients, minimally invasive robotic or laparoscopic surgeries were associated with fewer complications and less days of hospitalization relative to open surgery. Compared to laparoscopic approach, robotic surgeries had comparable rates of complications but higher charges.
OBJECTIVE: To compare the complications and charges of robotic vs. laparoscopic vs. open surgeries in morbidly obesepatients treated for endometrial cancer. METHODS: Data were obtained from the Nationwide Inpatient Sample from 2011. Chi-squared, Wilcoxon rank sum two-sample tests, and multivariate analyses were used for statistical analyses. RESULTS: Of 1087 morbidly obese (BMI ≥40kg/m(2)) endometrial cancerpatients (median age: 59years, range: 22 to 89), 567 (52%) had open surgery (OS), 98 (9%) laparoscopic (LS), and 422 (39%) robotic surgery (RS). 23% of OS, 13% of LS, and 8% of RSpatients experienced an intraoperative or postoperative complication including: blood transfusions, mechanical ventilation, urinary tract injury, gastrointestinal injury, wound debridement, infection, venous thromboembolism, and lymphedema (p<0.0001). RS and LS patients were less likely to receive blood transfusions compared to OS (5% and 6% vs. 14%, respectively; p<0.0001). The median lengths of hospitalization for OS, LS, and RSpatients were 4, 1, and 1days, respectively (p<0.0001). Median total charges associated with OS, LS, and RS were $39,281, $40,997, and $45,030 (p=0.037), respectively. CONCLUSIONS: In morbidly obese endometrial cancerpatients, minimally invasive robotic or laparoscopic surgeries were associated with fewer complications and less days of hospitalization relative to open surgery. Compared to laparoscopic approach, robotic surgeries had comparable rates of complications but higher charges.
Authors: Rudy S Suidan; Weiguo He; Charlotte C Sun; Hui Zhao; Nicole D Fleming; Pedro T Ramirez; Pamela T Soliman; Shannon N Westin; Karen H Lu; Sharon H Giordano; Larissa A Meyer Journal: Gynecol Oncol Date: 2017-01-26 Impact factor: 5.482
Authors: Osayande Osagiede; Christopher C DeStephano; Jordan J Cochuyt; Dorin T Colibaseanu; Matthew A Robertson; Aaron C Spaulding Journal: J Gynecol Surg Date: 2019-05-29
Authors: Kristin Bixel; David A Barrington; Monica H Vetter; Adrian A Suarez; Ashley S Felix Journal: J Minim Invasive Gynecol Date: 2021-08-01 Impact factor: 4.137