Decreased Postoperative Opiate Use Following Implementation of a Multimodal Perioperative Medication Pathway [12Q]

Abstract

INTRODUCTION: The purpose of this study was to compare cost and outcomes between laparoscopy and robotic-assistance in women undergoing complex myomectomy.METHODS: This is a retrospective cohort study of women undergoing minimally invasive myomectomy from January 2014 to December 2014. Women with dominant myoma diameter .8 cm and/or specimen weight .250 g and/or .5 myomata removed were compared by surgical modality. RESULTS:The cohort consisted of 70 patients with 54% laparoscopic and 46% robotic myomectomies. The robotic group had lower rates of concomitant procedures (32% versus 2%, P5.014), mean (SD) specimen weights in grams (351.5 [417.6] versus 574.0 [525.5], P5.014), and mean (SD) operative time (ORT) in minutes (150 [62.9] versus 216.7 [84.8], P5.0006), but no difference in number of myomata removed (median [range] 4 [1-16] versus 4 [1-20], P5.057) or diameter of dominant myoma in centimeters (median [range] 8 [2-20] versus 10 [2-20], P5.18). Estimated blood loss (EBL) and complication rates were equivalent. The mean (SD) direct cost in dollars for robotic cases was lower (5,861.3 [2,273.9] versus 7,081.7 [3,373.5], P5.0402). Indirect costs did not differ. In a logistic regression model, cost increased with ORT, specimen weight, EBL, prior laparotomy, complications, and length of stay, but not by surgical modality.CONCLUSION: In this pilot study of expert surgeons using their preferred modality for complex myomectomy, outcomes and costs were comparable. Costs were influenced by factors that increased surgical complexity and were contained in the robotics group. This preliminary data demonstrates a potential capacity for cost containment with the use of robotic surgery.INTRODUCTION: To examine the relationships between different colpopexy approaches and pre-operative and post-operative pelvic pain. METHODS:We extracted and analyzed data from ClinformaticsÔ DataMart (CDM) which is large national commercial insurance database. Using a retrospective cohort approach, data was collected from 9,180 patients between the ages of 18-64 who underwent colpopexy between 2005 and 2012. Cases were selected using ICD-9 and CPT codes. Logistic regression analysis was performed using SAS software. Data were analyzed to determine relationships between pre-operative and post-operative pain, pain and concomitant hysterectomy and pelvic floor repairs, and pelvic pain and surgical approach.RESULTS: A total of 18,092 patients underwent colpopexy between January 2005 and May 2012. Of which, 9,180 met criteria and data from these cases was analyzed. Younger patients were more likely to have pre-operative pain. Vaginal colpopexy was associated with more postoperative pain compared to abdominal (OR 1.53, 95% CI 1.08-2.18). Concomitant hysterectomy was associated with less postoperative pain (OR 0.54, 95% CI 0.36-0.8). Concomitant vaginal repair were associated with more postoperative pain for those without prior pain (OR 1.85, 95% CI 1.21-2.83).CONCLUSION: Patients with pre-operative pain were more likely to undergo an abdominal co...