62: Robotic-assisted laparoscopy versus conventional laparoscopy for the treatment of endometriosis in New York state, 2009-2016

Abstract

To describe the effect of patient and physician factors on utilization trends and short-term outcomes of robotic versus laparoscopic surgery for endometriosis in New York State. Using the Statewide Planning and Research Cooperative System (SPARCS) database, an all-payer administrative system on all hospital discharges in New York State, we identified patients undergoing minimally invasive surgery with a diagnosis of endometriosis from 2009 to 2016. Primary outcomes of interest were facility type, surgeon characteristics, patient demographics, and complications. Pearson chi-square, Mann-Whitney U test, and logistic regression analyses were performed. In a total cohort of 9,871 patients who underwent surgery for endometriosis, 49% of cases were performed utilizing a minimally invasive approach (35% conventional laparoscopy and 14% with robotic assistance). While the total number of surgeries has decreased by as much as 50% over the course of eight years, the proportion of cases done by a minimally invasive approach has almost doubled; 36% to 60%. There was a threefold increase in the number or robotic cases while the number of laparoscopic cases declined by 35%. The percentage of procedures performed robotically was significantly higher among female surgeons and younger physicians. On a multivariate analysis surgeon’s age remained a significant predictor of the type of minimally invasive surgery performed. Over 60% of all robotic cases were performed in New York City and Finger Lakes Area, 95% of which were performed at teaching affiliated institutions. A significantly higher percentage of patients in the robotic group were white and privately insured. No difference in complication rates were observed between the two groups irrespective of physician gender, surgical volume, experience or practice setting. Patients who underwent laparoscopic surgery were more likely to have a prolonged hospital stay than those who underwent robotic surgery. Prolonged stay was also noted among surgeons with a low surgical volume. Robotic cases had higher 30-day re-admission rate compared to cases done laparoscopically. Close to 60 percent of surgical procedures for endometriosis in New York State is performed using a minimally invasive approach. While numerous studies show no improvement in perioperative outcomes with robotic platform utilization, the number of robotic procedures in New York has increased over time in particularly among younger, less experienced surgeons. Surgeon gender does not appear to influence the type of the approach. No difference in complication rates were observed between the two groups.