Comparing robot-assisted with conventional laparoscopic hysterectomy: impact on cost and clinical outcomes.

摘要

OBJECTIVE: To compare clinical and economic outcomes (hospital costs) in women undergoing laparoscopic hysterectomy performed with and without robotic assistance in inpatient and outpatient settings. METHODS: Using the Premier hospital database, we identified women >18 years of age with a record of minimally invasive hysterectomy performed in 2007 to 2008. Univariable and multivariable analyses examined the association between robot-assisted hysterectomy and adverse events, hospital costs, surgery time, and length of stay. RESULTS: Of 36,188 patient records analyzed from 358 hospitals, 95% (n = 34,527) of laparoscopic hysterectomies were performed without robotic assistance. Inpatient and outpatient settings did not differ substantively in frequency of adverse events. For cardiac, neurologic, wound, and vascular complications, frequencies were <1% for robot and non-robot procedures. In inpatient and outpatient settings alike, use of robotic assistance was consistently associated with statistically significant, higher per-patient average hospital costs. Inpatient procedures with and without robotic assistance cost Dollars 9640 (95% confidence interval [CI] = Dollars 9621, Dollars 9659) versus Dollars 6973 (95% CI = Dollars 6959, Dollars 6987), respectively. Outpatient procedures with and without robotic assistance cost Dollars 7920 (95% CI = Dollars 7898, Dollars 7942) versus Dollars 5949 (95% CI = Dollars 5932, Dollars 5966), respectively. Inpatient surgery times were significantly longer for robot-assisted procedures, 3.22 hours (95% CI = 3.21, 3.23) compared with non-robot procedures at 2.82 hours (95% CI = 2.81, 2.83). Similarly, outpatient surgery times with robot averaged 2.99 hours (95% CI = 2.98, 3.00) versus 2.46 hours (2.45, 2.47) for non-robot procedures. CONCLUSION: Our findings reveal little clinical differences in perioperative and postoperative events. This, coupled with the increased per-case hospital cost of the robot, suggests that further investigation is warranted when considering this technology for routine laparoscopic hysterectomies.