A Comparison of Quality Outcome Measures in Patients Having a Hysterectomy for Benign Disease: Robotic vs. Non-robotic Approaches

Martino, Martin A; Berger, Elizabeth; McFetridge, Jeffrey T.; Shubella, Jocelyn; Gosciniak, Gabrielle; Wejkszner, Taylor; Kainz, Gregory; Patriarco, J.; Thomas, Maria; Boulay, Richard

doi:10.1016/j.jmig.2013.10.008

Cited by 51 publications

(27 citation statements)

References 10 publications

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“…In the comparison of robotic versus laparoscopic hysterectomy, meta-analyses of surgical outcomes, mostly from observational cohort studies, have shown quite mixed results. Some reviews have found evidence for select advantages of robotic technique, particularly shorter length of stay, in pooled analyses of benign hysterectomy, and combining hysterectomy for both benign and malignant disease (11–13,15). However, many reviews have demonstrated no significant advantages of robotic over laparoscopic technique for clinical outcomes in hysterectomy for benign disease (9,10,14).…”

Section: Introductionmentioning

confidence: 99%

Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials

Albright

Witte

Tofte

et al. 2016

Journal of Minimally Invasive Gynecology

117

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We conducted a systematic review and meta-analysis to assess the safety and effectiveness of robotic versus laparoscopic hysterectomy in women with benign uterine disease, as determined by randomized studies. We searched MEDLINE, EMBASE, the Cochrane Library, ClinicalTrials.gov, and Controlled-Trials.com from inception to October 9th, 2014, using the intersection of the themes “robotic” and “hysterectomy.” We included only randomized and quasi-randomized controlled trials of robotic versus laparoscopic hysterectomy in women for benign disease. Four trials met inclusion criteria and were included in the analyses. Data was extracted and studies were assessed for methodological quality in duplicate. For meta-analysis, we used random effects to calculate pooled risk ratios (RR) and weighted mean differences. For our primary outcome, we used a modified version of the Expanded Accordion Severity Grading System to classify perioperative complications. We identified 41 total complications among 326 patients. When comparing robotic to laparoscopic hysterectomy, we found no statistically significant differences in the rate of class 1 and 2 complications (RR=0.66, 95% Confidence Interval (CI) 0.23–1.89) or in the rate of class 3 and 4 complications (RR=0.99, 95%CI 0.22–4.40). Analyses of secondary outcomes were limited due to heterogeneity, but showed no significant benefit of robotic compared to laparoscopic technique in terms of length of hospital stay (weighted mean difference= −0.39 days, 95%CI −0.92–0.14), total operating time (weighted mean difference=9.0 minutes, 95%CI −31.27–47.26), conversions to laparotomy, or blood loss. Outcomes of cost, pain, and quality of life were inconsistently reported and not amenable to pooling. Current evidence demonstrates neither statistically significant, nor clinically meaningful differences in surgical outcomes between robotic and laparoscopic hysterectomy for benign disease. The role of robotic surgery in benign gynecology remains unclear.

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Section: Introductionmentioning

confidence: 99%

Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials

Albright

Witte

Tofte

et al. 2016

Journal of Minimally Invasive Gynecology

117

View full text Add to dashboard Cite

show abstract

“…The rate of readmission in prior studies varies from 1.1% to 6.7%. [5][6][7][8] For sameday discharges, the largest analysis was completed by Schiavone et al 5 looking at 128,634 patients from an administrative database using reimbursement claims. The readmission rate for a same-day discharge was 4.0% compared with a readmission rate of 3.6% for those discharged on the day following surgery.…”

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confidence: 99%

Predictors of 30-day readmission and impact of same-day discharge in laparoscopic hysterectomy

Jennings

Spencer

Medlin

et al. 2015

American Journal of Obstetrics and Gynecology

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“…Our study would need larger numbers for readmission costs to be meaningful. A recent study with larger numbers showed a decrease readmission rate and lower overall costs with robotic-assisted hysterectomies versus all other types of hysterectomies [20]. …”

Section: Discussionmentioning

confidence: 99%

Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy

et al. 2015

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The aim of the study was to assess if the cost of robotic-assisted total laparoscopic hysterectomy is similar to the cost of standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve. A retrospective chart review of all hysterectomies was performed for benign indications without concomitant major procedures at Orange Coast Memorial Medical Center (OCMMC) and Saddleback Memorial Medical Center between January 1, 2013 and September 30, 2013. Robotic-assisted total laparoscopic hysterectomies (RTLH) and standard laparoscopic hysterectomies (LAVH and TLH) were compared. Data analyzed included only those hysterectomies performed by surgeons past their initial learning curve (minimum of 30 previous robotic cases). The primary outcome was the direct total cost of patient’s hospitalization related to hysterectomy. The secondary outcomes were estimated blood loss, surgery time, and days in hospital post-surgery. A multiple linear regression model was applied to evaluate the difference between RTLH and LAVH/TLH in hospital cost, blood loss, and surgery time, while adjusting for hospital, patient’s age, body mass index (BMI), whether or not the patient had previous abdominal/pelvic surgery, and uterine weight. The χ2 test was applied to examine the association between hospital stay and surgery type. There were 93 hysterectomies (5 LAVH, 88 RTLH) performed at OCMMC and 90 hysterectomies (6 LAVH, 17 TLH, 67 RTLH) performed at Saddle-back Memorial Medical Center. The hospitalization total cost result showed that, after adjusting for hospital, age, BMI, previous abdominal/pelvic surgery, and uterine weight, RTLH was not significantly more expensive than LAVH/TLH (mean diff. = $283.1, 95 % CI = [−569.6, 1135.9]; p = 0.51) at the 2 study hospitals. However, the cost at OCMMC was significantly higher than Saddleback Memorial Medical Center (mean diff. = $2008.7, 95 % CI = [1380.6, 2636.7]; p < 0.0001); and the cost increased significantly with uterine weight (β = 3.8, 95 % CI = [2.3, 5.3]; p < 0.0001). Further analysis showed significantly less blood loss (mean diff. = −78.5 ml, 95 % CI = [−116.8, −40.3]; p < 0.0001) and shorter surgery time (mean diff. = −21.9 min., 95 % CI = [−39.6, −4.2]; p = 0.016) for RTLH versus LAVH/TLH. There was no significant association between hospital stay and surgery type (p = 0.43). After adjusting for patient-level covariates, there was no statistically significant cost difference of performing robotically assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve at two community hospitals.

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A Comparison of Quality Outcome Measures in Patients Having a Hysterectomy for Benign Disease: Robotic vs. Non-robotic Approaches

Cited by 51 publications

References 10 publications

Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials

Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials

Predictors of 30-day readmission and impact of same-day discharge in laparoscopic hysterectomy

Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy

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