Route of hysterectomy and surgical outcomes from a statewide gynecologic oncology population: is there a role for XXXX ?

@entity1 @entity43 @entity5 @entity1661 @entity260 @entity365
BACKGROUND: Recent policy changes by insurance companies have been instituted to encourage @entity365 ( @entity365 ) as the preferred route for removal of the uterus. It is not known if advantages of @entity365 for benign indications apply to @entity1 with @entity5 . OBJECTIVE: The goal of this study was to assess trends in surgical approach to hysterectomy among @entity5 @entity1 and to evaluate outcomes by approach. We hypothesized that, among gynecologic oncology @entity1 , @entity260 and hospital stay would differ by surgical approach, and that advantages of @entity365 for benign indications may not apply to @entity5 @entity1 . STUDY DESIGN: We performed a population-based retrospective cohort study of cervical, endometrial, or @entity43 @entity1 treated surgically in Washington State from 2004 through 2013 using the Comprehensive Hospital Abstract Reporting System. Surgery was categorized as @entity1661 ( @entity1661 ), laparoscopic hysterectomy (LH), or @entity365 . We determined rate of surgical approach by year and the association with length of stay, 30-day readmission rate, and perioperative complications. RESULTS: We identified 10,117 @entity1 who underwent surgery for @entity5 , with 346 (3.4%) @entity365 , 2698 (26.7%) LH, and 7073 (69.9%) @entity1661 . @entity1 undergoing @entity1661 had more comorbidities than @entity1 with @entity365 or LH (Charlson Comorbidity Index >= 2: 11.3%, 7.9%, and 8.1%, respectively; P < .001). From 2004 through 2013 @entity1661 and @entity365 declined (94.4-47.9% and 4.4-0.8%, respectively; P < .001) while LH increased from 1.2-51.4% in 2013 (P < .001). Mean length of stay was 4.6 days for @entity1 undergoing @entity1661 and was 1.9 days shorter for @entity365 (95% confidence interval, 1.6-2.3 days) and 2.6 days shorter for LH (95% confidence interval, 2.4-2.7 days) (P < .001). Risk of 30-day readmission for @entity1 undergoing LH was 40% less likely compared to @entity1661 but not different for @entity365 vs @entity1661 . CONCLUSION: @entity1661 and LH remain the preferred routes for hysterectomy in gynecologic oncology. Over the past decade, there has been a significant shift to LH with lower 30-day readmission and complication rates. There may be a limited role for @entity365 in select @entity1 . Current efforts to standardize the surgical approach to hysterectomy should not apply to @entity1 with known or suspected @entity5 .
