2140 ABDOMINAL COLPOPEXY: COMPARISON OF ENDOSCOPIC SURGICAL STRATEGIES

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20122140 ABDOMINAL COLPOPEXY: COMPARISON OF ENDOSCOPIC SURGICAL STRATEGIES Jennifer Anger, Elizabeth Mueller, Chris Tarnay, Linda Brubaker, Amy Rosenman, Bridget Smith, Kevin Stroupe, Catherine Bresee, and Kimberly Kenton Jennifer AngerJennifer Anger Los Angeles, CA More articles by this author , Elizabeth MuellerElizabeth Mueller Maywood, IL More articles by this author , Chris TarnayChris Tarnay Los Angeles, CA More articles by this author , Linda BrubakerLinda Brubaker Maywood, IL More articles by this author , Amy RosenmanAmy Rosenman Los Angeles, CA More articles by this author , Bridget SmithBridget Smith Maywood, IL More articles by this author , Kevin StroupeKevin Stroupe Maywood, IL More articles by this author , Catherine BreseeCatherine Bresee Los Angeles, CA More articles by this author , and Kimberly KentonKimberly Kenton Maywood, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic (LASC) and robotic (RASC) sacrocolpopexy are widely used for the treatment of pelvic organ prolapse (POP). However, strong evidence comparing outcomes and costs for the procedures is lacking. METHODS Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS, NCT01124916) is a 2-center randomized comparative effectiveness trial conducted at UCLA/Cedars-Sinai and Loyola University Medical Centers. The primary aim compared costs of RASC and LASC. Following a clinical decision for ASC and research consent, participants with greater than or equal to symptomatic stage II POP including apical support loss to greater than 0.5 TVL were randomized to LASC or RASC on the day of surgery. Concomitant surgeries, including hysterectomy, posterior repair, and midurethral sling were allowed. Costs of care were based on each patient's billing record and equipment costs at each hospital. All costs associated with surgical procedure including costs for robot, initial hospitalization, and any re-hospitalization in the 1st 6 weeks were compared between groups. Secondary outcomes included postoperative pain, POP quantification, symptom severity and quality of life, and adverse events (AE). Power calculation determined that 32 women in each arm would provide > 99% power to detect $4800 difference in total charges, using a 2-sided t-test with significance level of 0.05. RESULTS 78 women with mean age of 59 years (range 26-79) were randomized: LASC (38) and RASC (40). Hospital costs for RASC were higher than for LASC ($20,459 vs $12,022, P<0.0001). Over 6 weeks, hospital costs remained higher for RASC ($24,870 vs $13,840, P=0.008). Excluding costs of robot, hospital costs of RASC vs LASC ($13,428 vs $12,022, P = 0.06) and hospital costs over 6 weeks ($17,839 vs $13,840, P=0.32) were not significantly different. Total operating room time for RASC was slightly longer (202 vs 179 minutes, P=0.03). Women with RASC reported higher pain scores by visual assessment scales 1-week after surgery; however, pain scores did not differ by 2-weeks. There were no differences in complications, symptom bother, or POP stage three months after surgery. CONCLUSIONS Costs of RASC are higher than LASC, while short-term outcomes and complications are similar. Primary cost differences resulted from robot maintenance and purchase costs. Variable LASC RASC P value Baseline 3 months Basline 3 months Mean UDI (SD) 99.0(60.6) 25.6(41.4) 110.7(59.4) 30.3(42.1) 0.50 POPDI (SD) 116.4(61.6) 27.5(27.8) 126.1(63.9) 32.7(45.4) 0.65 CRADI (SD) 100.6(34.3) 34.3(34.0) 87.9(71.5) 44.1(48.3) 0.12 POPQ Point Ba (SD) 2.5(1.8) −2.4(1.2) 2.6(2.0) −2.6(0.7) 0.74 POPQ Point C (SD) 0.7(3.6) −7.7(4.8) 0.2(4.0) −7.9(5.1) 0.98 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e864 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Anger Los Angeles, CA More articles by this author Elizabeth Mueller Maywood, IL More articles by this author Chris Tarnay Los Angeles, CA More articles by this author Linda Brubaker Maywood, IL More articles by this author Amy Rosenman Los Angeles, CA More articles by this author Bridget Smith Maywood, IL More articles by this author Kevin Stroupe Maywood, IL More articles by this author Catherine Bresee Los Angeles, CA More articles by this author Kimberly Kenton Maywood, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...