Long term resource consequences of a nationwide introduction of robotic surgery for women with early stage endometrial cancer

Korsholm, Malene; Gyrd‐Hansen, Dorte; Mogensen, Ole; Möller, Sören; Sopina, Elizaveta; Joergensen, Siv L.; Jensen, Pernille Tine

doi:10.1016/j.ygyno.2019.05.027

Cited by 11 publications

(11 citation statements)

References 40 publications

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“…By using an ERAS programme with standardised discharge criteria and by treating both groups similarly we were able to demonstrate the actual short and similar length of hospital stay in both groups from time of arrival in the operating theatre to discharge from the ward. In accordance with our findings, a recently published Danish study investigating the long-term resource consequences of introducing robotic surgery for treatment of early endometrial cancer, could not demonstrate a significant difference in days of hospitalisation when adjusting for time trends (Korsholm, et al 2019). The robotic surgery generated additional costs, and no long term cost savings.…”

Section: Cost-effectiveness and Qalysupporting

confidence: 90%

On Quality Improvement in Gynaecological Cancer Surgery

Lundin

2020

Linköping University Medical Dissertations

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Objectives: The overall purpose of this thesis was to find medical and surgical treatment methods of improving the perioperative care of gynaecological cancer patients. The specific objectives were to determine whether a single dose tranexamic acid given immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and the need for blood transfusions, and to determine whether postoperative recovery, tissue damage, and inflammatory response markers differ between women operated with robotic and abdominal hysterectomy for low-risk endometrial cancer in an enhanced recovery after surgery (ERAS) programme, and to evaluate costs for hospital stay and postoperative recovery in relation to health impact. Material and Methods: The thesis was based on two randomised trials. The first trial was a randomised double-blind placebo-controlled multicentre study conducted in four hospitals in the southeast and central of Sweden between March 2008 and May 2012. One hundred women with presumed advanced ovarian cancer who had been scheduled for radical debulking surgery were included; 50 received tranexamic acid and 50 received a placebo. The main outcomes were blood loss and red blood cell transfusions. The second trial was a randomised open single centre trial at a Swedish university hospital, which included 50 women with low-risk endometrial cancer scheduled for radical surgery between February 2012 and May 2016; 25 women underwent robotic hysterectomy and 25 had abdominal hysterectomy. Anaesthesia and perioperative care followed an ERAS protocol in both groups. The EuroQol Group form EQ-5D-3L and the Short Form-36 evaluated the health-related quality of life. The Swedish Postoperative Symptoms Questionnaire assessed symptoms perioperatively until six weeks postoperatively. Venous blood samples were collected on several occasions until six weeks postoperatively and were analysed for markers reflecting inflammatory response and tissue damage. In addition, a health-economy analysis was conducted comparing total costs, quality-adjusted life years (QALYs) and cost per QALY between the surgical methods. Results: Total blood loss volume and transfusion rate following surgery in advanced ovarian cancer were significantly lower in the tranexamic group compared with the placebo group. Women with early endometrial cancer treated by robotic hysterectomy recovered significantly faster in the EQ-5D health index, and reached their preoperative level nearly two weeks earlier than the abdominal group. Differences regarding improvement in health-related quality of life (Short Form-36) comprising general health and social functioning were more favourable in the robotic hysterectomy group. Consumption of analgesics, pain intensity, postoperative symptom sum score and length of hospital stay were equal between the groups. The occurrence of complications was an independent risk factor and influenced most of the outcome measures adversely. Postoperative inflammatory response and tissue damage were lower after roboti...

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Section: Cost-effectiveness and Qalysupporting

confidence: 90%

On Quality Improvement in Gynaecological Cancer Surgery

Lundin

2020

Linköping University Medical Dissertations

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“…A longer recovery time may impact on patient and employment costs, with greater loss of earnings and longer return to work or contribution to society activities as compared with MIS. Korsholm et al 18 reported no significant difference in return to the labour market or use of sickness benefits in a study from Denmark, however; in their study, robotic surgery was associated with greater cost than both LH and OH, unlike this UK analysis. Allowing for a number of OH cases, the disparity in MIS uptake across England 8 does indicate that there is room for improvement in increasing the proportion of MIS cases thereby benefiting both the patient and the healthcare economy.…”

Section: Discussionmentioning

confidence: 56%

Economic evaluation of different routes of surgery for the management of endometrial cancer: a retrospective cohort study

Moss

Morgan²,

Martin³

et al. 2021

BMJ Open

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ObjectivesThe benefits of minimally invasive surgery (MIS) for endometrial carcinoma (EC) are well established although the financial impact of robotic-assisted hysterectomy (RH) compared with laparoscopic hysterectomy (LH) is disputed.DesignRetrospective cohort study.SettingEnglish National Health Service hospitals 2011–2017/2018.Participants35 304 women having a hysterectomy for EC identified from Hospital Episode Statistics.Primary and secondary outcome measuresThe primary outcome was the association between route of surgery on cost at intervention, 30, 90 and 365 days for women undergoing an open hysterectomy (OH) or MIS (LH/RH) for EC in England. The average marginal effect was calculated to compare RH versus OH and RH versus LH which adjusted for any differences in the characteristics of the surgical approaches. Secondary outcomes were to analyse costing data for each surgical approach by age, Charlson Comorbidity Index (CCI) and hospital MIS rate classification.ResultsA total of 35 304 procedures were performed, 20 405 (57.8%) were MIS (LH: 18 604 and RH: 1801), 14 291 (40.5%) OH. Mean cost for LH was significantly less than RH, whereas RH was significantly less than OH at intervention, 30, 90 and 365 days (p<0.001). Over time, patients who underwent RH had increasing CCI scores and by the 2015/2016 year had a higher average CCI than LH. Comparing the cost of LH and RH against CCI score identified that the costs closely reflected the patients’ CCI. Increasing disparity was also seen between the MIS and OH costs with rising age. When exploring the association between provider volume, MIS rate and surgical costs, there was an association with the higher the MIS rate the lower the average cost.ConclusionsFurther research is needed to investigate costs in matched patient cohorts to determine the optimum surgical modality in different populations.

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“…In recent population‐based studies we showed that a nationwide Danish adoption of RAS completely transitioned the surgical approach to minimally invasive surgery and was, in general, associated with a reduced risk of severe complications and improved survival; primarily for two‐thirds of the patients who were defined as frail 29,30 . In the present study, more than two‐thirds of the patients underwent RAS at the end of the observation period and this incurred, in general, increased costs 31 . The present study suggests that this is not the case for obese women.…”

Section: Discussionmentioning

confidence: 47%

Post robotic investment: Cost consequences and impact on length of stay for obese women with endometrial cancer

Korsholm

Gyrd‐Hansen

Mogensen

et al. 2021

Acta Obstet Gynecol Scand

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Long term resource consequences of a nationwide introduction of robotic surgery for women with early stage endometrial cancer

Abstract: Long term resource consequences of a nationwide introduction of robotic surgery for women with early stage endometrial cancer Malene Korsholm, MScPH ad

Cited by 11 publications

References 40 publications

On Quality Improvement in Gynaecological Cancer Surgery

On Quality Improvement in Gynaecological Cancer Surgery

Economic evaluation of different routes of surgery for the management of endometrial cancer: a retrospective cohort study

Post robotic investment: Cost consequences and impact on length of stay for obese women with endometrial cancer

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