Date

May 2012

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

OBJECTIVE: To compare surgical outcomes, hospital charges, and patient satisfaction among women undergoing total laparoscopic hysterectomy for non-malignant indications with and without robotic assistance. METHODS: Retrospective chart review was conducted for patients who underwent total laparoscopic hysterectomy for non-malignant indications at two community hospitals and a neighboring academic medical center from 2008 - 2010. Subjects were invited to complete follow-up questionnaires. RESULTS: Hospital records were searched using an ICD9-based search protocol, yielding 411 cases that were screened for inclusion. There were 299 cases that met study criteria, 134 (44.8%) of which involved robotic assistance. Data were extracted by manual chart review of electronic records. Patients in the robotic group had greater age, BMI, and history of cancer. Robotic assistance resulted in greater total hospital charges, although significant interaction was discovered whereby increased charges associated with robotic assistance were localized to two of the three hospitals studied. Robotic assistance was not associated with significant differences in operative time, estimated blood loss >100mL, conversion to open laparotomy, major complications, or likelihood of prolonged hospital stay, although significant interaction was found between hospital site and odds of prolonged hospital stay. Ninety-nine subjects (33%) completed questionnaires. Among respondents, robotic assistance did not demonstrate superior patient satisfaction or recovery experience. CONCLUSION: In women undergoing total laparoscopic hysterectomy for non-malignant indications, robotic assistance was associated with greater total hospital charges. These data do not demonstrate significant benefit in operative time, estimated blood loss, length of stay, or patient satisfaction among patients whose operations involved robotic assistance. Patients with increased age, BMI, or personal history of cancer may be more likely to receive robotic-assistance when undergoing total laparoscopic hysterectomy.

Identifier

doi:10.6083/M4P26W4J

School

School of Medicine

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