Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease

• Published in: JAMA : the journal of the American Medical Association 2013-02, Vol.309 (7), p.689-698
• Main Authors: Wright, Jason D, Ananth, Cande V, Lewin, Sharyn N, Burke, William M, Lu, Yu-Shiang, Neugut, Alfred I, Herzog, Thomas J, Hershman, Dawn L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cohort Studies; Digestive system. Abdomen; Endoscopy; Female; General aspects; Genital Diseases, Female - surgery; Gynecology; Health Care Costs; Humans; Hysterectomy; Hysterectomy - economics; Hysterectomy - methods; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - economics; Laparoscopy - methods; Laparoscopy - utilization; Medical sciences; Middle Aged; Postoperative Complications; Propensity Score; Robotics; Robotics - economics; Robotics - methods; Robotics - utilization; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Surgical outcomes; Surgical techniques; Treatment Outcome; United States; Womens health
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2013.186

IMPORTANCE Although robotically assisted hysterectomy for benign gynecologic conditions has been reported, little is known about the incorporation of the procedure into practice, its complication profile, or its costs compared with other routes of hysterectomy. OBJECTIVES To analyze the uptake of robotically assisted hysterectomy, to determine the association between use of robotic surgery and rates of abdominal and laparoscopic hysterectomy, and to compare the in-house complications of robotically assisted hysterectomy vs abdominal and laparoscopic procedures. DESIGN, SETTING, AND PATIENTS Cohort study of 264 758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the United States from 2007 to 2010. MAIN OUTCOME MEASURES Uptake of and factors associated with utilization of robotically assisted hysterectomy. Complications, transfusion, reoperation, length of stay, death, and cost for women who underwent robotic hysterectomy compared with both abdominal and laparoscopic procedures were analyzed. RESULTS Use of robotically assisted hysterectomy increased from 0.5% in 2007 to 9.5% of all hysterectomies in 2010. During the same time period, laparoscopic hysterectomy rates increased from 24.3% to 30.5%. Three years after the first robotic procedure at hospitals where robotically assisted hysterectomy was performed, robotically assisted hysterectomy accounted for 22.4% of all hysterectomies. The rates of abdominal hysterectomy decreased both in hospitals where robotic-assisted hysterectomy was performed as well as in those where it was not performed. In a propensity score–matched analysis, the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR], 1.03; 95% CI, 0.86-1.24). Although patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR, 0.78, 95% CI, 0.67-0.92), transfusion requirements (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55-1.16) and the rate of discharge to a nursing facility (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35-1.76) were similar. Total costs associated with robotically assisted hysterectomy were $2189 (95% CI, $2030-$2349) more per case than for laparoscopic hysterectomy. CONCLUSIONS AND RELEVANCE Between 2007 and 2010, the use of robotically assisted hysterectomy for benign gynecologic disorders increased substantially. Robotically assisted and laparoscopic hysterectomy