TY - JOUR
T1 - Implementing robotic surgery for uterine cancer in the United States
T2 - Better outcomes without increased costs
AU - Casarin, Jvan
AU - Song, Chao
AU - Multinu, Francesco
AU - Cappuccio, Serena
AU - Liu, Emelline
AU - Butler, Kristina A.
AU - Glaser, Gretchen E.
AU - Cliby, William A.
AU - Langstraat, Carrie L.
AU - Ghezzi, Fabio
AU - Fu, Alex Z.
AU - Mariani, Andrea
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Objective: To examine the effect of robotic-assisted surgery implementation for treatment of endometrial cancer in the United States on 30-day clinical outcomes and costs. Methods: We retrospectively reviewed data of adult patients who underwent total hysterectomy for endometrial cancer in the US hospitals in Premier Healthcare Database between January 1, 2008 and September 30, 2015. We conducted trend analyses comparing the proportions of surgical approaches with the associated clinical outcomes and costs over the study period using Mann-Kendall tests. Clinical outcomes and costs of robotic-assisted surgery, laparoscopic and open surgery have been compared after propensity score 1:1 matching in the most recent 3 years (January 1, 2013–September 30, 2015). Results: Of a total of 35,224 patients, use of robotic-assisted surgery increased from 9.48% to 56.82% while open surgery decreased from 70.4% to 28.1% over the study period. A 2.5% decrease in major complications (P < .001), a 2.9% decrease in minor complications (P = .001), and a 2.0% decrease 30-day readmissions (P = .001) was observed across all surgical approaches. Perioperative 30-day total cost slightly decreased from US $11,048 to US $10,322 (P = .08). Among propensity-score matched patients, robotic-assisted surgery was associated with shorter hospitalization than open surgery (median [interquartile range], 2.0 [2.0–3.0] vs 4.0 [3.0–6.0] days) and laparoscopic surgery (2.0 [2.0–3.0] vs 3.0 [2.0–4.0] days), fewer 30-day complications (20.1% vs 33.7%) (all P < .001), and comparable perioperative 30-day total costs (median [interquartile range], US $12,200 [US $9,509-US $16,341] vs US $12,018 [US $8,996-US $17,162]; P = .34) with open surgery. Conclusion: Robotic-assisted surgery facilitated the widespread diffusion of a minimally invasive approach nationally for endometrial cancer, with reduction of perioperative morbidity and no increase in overall treatment-related 30-day costs at national level.
AB - Objective: To examine the effect of robotic-assisted surgery implementation for treatment of endometrial cancer in the United States on 30-day clinical outcomes and costs. Methods: We retrospectively reviewed data of adult patients who underwent total hysterectomy for endometrial cancer in the US hospitals in Premier Healthcare Database between January 1, 2008 and September 30, 2015. We conducted trend analyses comparing the proportions of surgical approaches with the associated clinical outcomes and costs over the study period using Mann-Kendall tests. Clinical outcomes and costs of robotic-assisted surgery, laparoscopic and open surgery have been compared after propensity score 1:1 matching in the most recent 3 years (January 1, 2013–September 30, 2015). Results: Of a total of 35,224 patients, use of robotic-assisted surgery increased from 9.48% to 56.82% while open surgery decreased from 70.4% to 28.1% over the study period. A 2.5% decrease in major complications (P < .001), a 2.9% decrease in minor complications (P = .001), and a 2.0% decrease 30-day readmissions (P = .001) was observed across all surgical approaches. Perioperative 30-day total cost slightly decreased from US $11,048 to US $10,322 (P = .08). Among propensity-score matched patients, robotic-assisted surgery was associated with shorter hospitalization than open surgery (median [interquartile range], 2.0 [2.0–3.0] vs 4.0 [3.0–6.0] days) and laparoscopic surgery (2.0 [2.0–3.0] vs 3.0 [2.0–4.0] days), fewer 30-day complications (20.1% vs 33.7%) (all P < .001), and comparable perioperative 30-day total costs (median [interquartile range], US $12,200 [US $9,509-US $16,341] vs US $12,018 [US $8,996-US $17,162]; P = .34) with open surgery. Conclusion: Robotic-assisted surgery facilitated the widespread diffusion of a minimally invasive approach nationally for endometrial cancer, with reduction of perioperative morbidity and no increase in overall treatment-related 30-day costs at national level.
KW - Costs
KW - Endometrial cancer
KW - Laparoscopy
KW - Minimally invasive surgery
KW - Morbidity
KW - Robotic surgery
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UR - http://www.scopus.com/inward/citedby.url?scp=85075896339&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2019.11.016
DO - 10.1016/j.ygyno.2019.11.016
M3 - Article
C2 - 31780236
AN - SCOPUS:85075896339
SN - 0090-8258
VL - 156
SP - 451
EP - 458
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 2
ER -