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The Implementation Of Robotic-Assisted Surgery For Endometrial Cancer In The United States Lead To An Improvement Of Overall 30-Day Surgical Outcomes Without Increasing Costs: Is Technology Finally Allowing The Diffusion Of Minimally Invasive Surgery At A National Level?

OBJECTIVES: To evaluate the role played by the introduction of robotic-assisted surgery for endometrial cancer(EC) treatment in the United States in terms of 30-day morbidity and costs over time. Also, to compare the clinical and economic outcomes that followed the change in surgical treatment. METH...

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Bibliographic Details
Published in:Value in health 2017-10, Vol.20 (9), p.A472
Main Authors: Casarin, J, Song, C, Multinu, F, Liu, E, Butler, K, Glaser, G, Ghezzi, F, Mariani, A
Format: Article
Language:English
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Summary:OBJECTIVES: To evaluate the role played by the introduction of robotic-assisted surgery for endometrial cancer(EC) treatment in the United States in terms of 30-day morbidity and costs over time. Also, to compare the clinical and economic outcomes that followed the change in surgical treatment. METHODS: The Premier Hospital Perspective Database was reviewed for adult patients who underwent elective total hysterectomy for EC(2008/0l-2015/09).Trend analyses for the proportions of surgical approaches, surgical and economics outcomes were performed. Outcomes were compared among surgical approaches after 1:1 Greedy propensity score matching. RESULTS: Overall, 35,224 EC patients were included. An increase in the use of Robotic-assisted hysterectomy(RH)(9.48% in 2008 to 56.82% in 2015) and a concomitant decrease in the use of Open hysterectomy(OH)(70.45% in 2008 to 28.08% in 2015) were observed over time. As a consequence, the rate of minimally invasive surgery increased from 27.59% to 70.65%. During the study period, the median length of stay(LOS) in US EC patients decreased from 4 to 3 days and 30-day readmission rates from 6.29% to 4.26%. The rate of any major complications decreased from 10.5% to 8,01%, p-for-trend=0.01; any minor complications went from 16.5% to 13.7%, urinary tract infections from 2.21% to 1.40%, and superficial surgical site infections from 2.94% to 1.50%(all P-for-trend< 0.05). A reduction of overall 30-day complications was registered (from 19.9% to 16.10%, P-value-for-trend: 0.05).Perioperative 30-day total cost from US$11048.17 slightly decreased to US$10322.76(all P-Values-for-trend
ISSN:1098-3015
1524-4733
DOI:10.1016/j.jval.2017.08.420