Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

OBJECTIVE: Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy. METHODS: Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. RESULTS: Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P5.002). In a propensitymatched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89-1.09, P5.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P,.001), but patients undergoing robotic hysterectomy weremore likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24-3.78, P5.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P,.001). Hospital costs were on average $2,489 (95% CI $2,313-2,664) higher for patients undergoing robotic hysterectomy. CONCLUSION: The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more.

Original languageEnglish (US)
Pages (from-to)778-786
Number of pages9
JournalObstetrics and Gynecology
Volume122
Issue number4
DOIs
StatePublished - Oct 2013

Fingerprint

Female Genital Diseases
Robotics
Hysterectomy
Hospital Costs
Confidence Intervals
Length of Stay
Logistic Models
Hospital Charges
Costs and Cost Analysis
Propensity Score

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{7007a1527d0f4bc397a592e4a1ccc299,
title = "Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease",
abstract = "OBJECTIVE: Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy. METHODS: Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. RESULTS: Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6{\%} were laparoscopic and 5.1{\%} robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5{\%} to 13.6{\%} (P5.002). In a propensitymatched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80{\%} compared with 8.85{\%}, relative risk 0.99, 95{\%} confidence interval [CI] 0.89-1.09, P5.910). There was a lower incidence of blood transfusions in robotic cases (2.1{\%} compared with 3.1{\%}; P,.001), but patients undergoing robotic hysterectomy weremore likely to experience postoperative pneumonia (relative risk 2.2, 95{\%} CI 1.24-3.78, P5.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P,.001). Hospital costs were on average $2,489 (95{\%} CI $2,313-2,664) higher for patients undergoing robotic hysterectomy. CONCLUSION: The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more.",
author = "Rosero, {Eric B.} and Kho, {Kimberly A.} and Joshi, {Girish P.} and Martin Giesecke and Schaffer, {Joseph I.}",
year = "2013",
month = "10",
doi = "10.1097/AOG.0b013e3182a4ee4d",
language = "English (US)",
volume = "122",
pages = "778--786",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease

AU - Rosero, Eric B.

AU - Kho, Kimberly A.

AU - Joshi, Girish P.

AU - Giesecke, Martin

AU - Schaffer, Joseph I.

PY - 2013/10

Y1 - 2013/10

N2 - OBJECTIVE: Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy. METHODS: Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. RESULTS: Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P5.002). In a propensitymatched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89-1.09, P5.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P,.001), but patients undergoing robotic hysterectomy weremore likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24-3.78, P5.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P,.001). Hospital costs were on average $2,489 (95% CI $2,313-2,664) higher for patients undergoing robotic hysterectomy. CONCLUSION: The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more.

AB - OBJECTIVE: Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy. METHODS: Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. RESULTS: Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P5.002). In a propensitymatched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89-1.09, P5.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P,.001), but patients undergoing robotic hysterectomy weremore likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24-3.78, P5.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P,.001). Hospital costs were on average $2,489 (95% CI $2,313-2,664) higher for patients undergoing robotic hysterectomy. CONCLUSION: The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more.

UR - http://www.scopus.com/inward/record.url?scp=84889831476&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889831476&partnerID=8YFLogxK

U2 - 10.1097/AOG.0b013e3182a4ee4d

DO - 10.1097/AOG.0b013e3182a4ee4d

M3 - Article

VL - 122

SP - 778

EP - 786

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 4

ER -