Laparoscopic and robot-assisted hysterectomy for uterine XXXX : a comparison of costs and complications.

@entity1 @entity8 @entity101 @entity6 @entity28 @entity5 @entity358 @entity65
OBJECTIVE: Increasingly, robotic surgery is being used for total hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for uterine @entity5 . The purpose of this study was to compare the costs and complications among @entity1 undergoing robotic and laparoscopic hysterectomy for uterine @entity5 . STUDY DESIGN: We carried out a cohort study using the Nationwide Inpatient Sample (NIS) database between 2008 and 2012 on all @entity1 diagnosed with uterine @entity5 , classifying @entity1 as either laparoscopically or robotically treated, excluding laparotomies or vaginal approaches. Logistic regression analyses were used to evaluate the adjusted effect of surgical approach on complication rates. RESULTS: There were 10,347 @entity1 who underwent hysterectomies for uterine @entity5 either laparoscopically (39%) or robotically (61%). The rate of robotic surgery consistently increased over the 5 year period. @entity1 undergoing robotic surgery had more comorbid conditions ( @entity6 , @entity101 , @entity65 , @entity8 , @entity28 or morbid @entity28 , and @entity358 ). In adjusted analyses, @entity1 undergoing robotic surgery were more likely to have a lymph node dissection (73.01% vs 66.04%; P < .0001) and an admission lasting <3 days (86.01% vs 82.5%; P < .0001) compared with those undergoing laparoscopic surgery. The composite endpoint of any complication was similar between both cohorts (20.56% robotic vs 21.00% laparoscopy). In overall and subset analyses, robotic surgery was more costly, with median charges of  38,161.00 compared with  31,476.00 in those undergoing laparoscopic surgery (P < .0001). CONCLUSION: Despite the considerably greater burden of comorbidities in those undergoing robotic surgery compared with laparoscopy, the former have shorter hospital admissions, a greater rate of lymph node dissection, and similar postoperative morbidity and mortality, albeit at greater total cost.
