Robotic surgery for the treatment of uterine malignancy

Abstract

Objectives: To describe trends in the adoption of robotic surgery for the treatment of uterine malignancy, and the associated impact of these trends on cost of treatment. Methods: University HealthSystem Consortium keeps an administrative database with contributions from over 100 academic medical centers and 250 affiliate hospitals, representing over 90% of US nonprofit academic medical centers. This database was queried to identify all patients with uterine malignancy (ICD-9 182.x, 179) undergoing total hysterectomy (ICD-9 684.x-689) from the 4th quarter of 2008 through the 2nd quarter of 2012. Trends in surgical approach, cost and clinical outcomes were compared by hysterectomy type, including open (OH), robotic (RH) and nonrobotic, minimally invasive (MH). Results: We compared the frequencies of OH, RH and MH in 2009 and 2011, as these were the earliest and most recent full calendar years for which data was available. In 2009 there were 62% OH, 22% RH and 16% MH, while in 2011 there were 54% OH, 32% RH and 14% MH. Since the 4th quarter of 2008, the fraction of RH has increased logarithmically, largely at the expense of OH, which has decreased logarithmically. Thus, we used data from the first two quarters of 2012 to compare current cost and clinical outcomes between OH and RH. Mean direct cost of hospitalization is over $1600 higher for OH as compared to RH. This may be related to the 2.8-fold longer length of stay, 2.4-fold higher complication rate and 2.1-fold higher readmission rate seen with OH as compared to RH. However, despite the increased use of RH over OH, and the reduced cost and complication rate seen with RH over OH, the mean cost of surgical treatment for all patients with uterine malignancy has increased linearly by $521 per year and the overall complication rate has not changed significantly over the period of this study. Conclusions: Although RH is associated with fewer complications and lower cost as compared to OH, and RH use is increasing while the rate of OH declines, we did not find the expected overall decrease in cost and complication rates when the surgical management of all patients with uterine malignancy was evaluated. Complication rates have remained the same and this, along with other factors, may be contributing to the steadily rising cost. A better understanding of the underlying elements associated with complications and cost may help to reduce complications and control costs without compromising quality of care.