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A Comparison Between Total Laparoscopic Hysterectomy and Abdominal Hysterectomy at TEC of Monterrey Healthcare System
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Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Design: Prospective, case-cohort study. Setting: Large, suburban, academic/teaching hospital. Patients: Women undergoing robotic-assisted gynecologic procedures. Intervention: Analog pain and satisfaction surveys were evaluated in women undergoing laparoscopic single-port and multi-port roboticassisted hysterectomies and/or salpingo-oophorectomies. Patients received surveys on post-operative day 0 or 1, and at their two-week and six-week post-operative visits, with questions regarding post-operative pain, satisfaction with the surgery and incision appearance, etc.. Results were controlled for potential confounding variables such as pre-operative diagnosis, specimen weight, and patient demographics. Evaluation of preoperative pain, intra-operative estimated blood loss, and length of stay were also evaluated and compared between the two groups. Measurements and Main Results: Patients who underwent single-port laparoscopic surgery had a significantly lower estimated blood loss (65 mL versus 107 mL, p=0.035). They also had lower pain scores postoperatively (current pain - 2.1/10 versus 5.1/10, p=0.001, and maximum pain - 4.8/10 versus 7.1/10, p=0.008). Lastly, length of stay postoperatively was shorter for patients in the single-port compared to the multi-port group (0.67 days vs. 1.18 days, p = 0.01).
(SD=15.25; p=0.1144). There were no significant differences between characteristics of both groups. Laparoscopic hysterectomies had a significantly lower hospital-stay (2.62 vs 3.45; p=0.0001), significantly less bleeding (200.44 vs 291.98; p=0.0001). Nonetheless, they presented with a significantly higher surgical time (145.39 vs 123.52; p=0.0001). There were no differences in terms of complications between both groups and finally there was an increased risk of wound infection in the abdominal group (RR=1.42, p=0.1144). Conclusion: Evidence suggests that patients undergoing laparoscopic hysterectomy presented with lower hospital-stay and less bleeding in comparison with patients who underwent abdominal hysterectomy. Patients who underwent abdominal hysterectomy had a significantly lower surgical time but an increased risk of wound infections. Complications were equivalent in both groups. Therefore, total laparoscopic hysterectomy is a feasible and a safe option for hysterectomy in our population.
Single-Port vs Multi-Port Robotic Surgery Results
Route of Hysterectomy and Risk of Readmission
Uterine Weight (grams) Estimated Blood Loss (cc) Current Pain (POD 0/1) Maximum Pain (POD 0/1) Length of Stay (days)
Single-Port
Multi-Port
Significance
204 65.0 2.1 4.8 0.67
333 107.0 5.1 7.1 1.18
NS p\0.05 p\0.001 p=0.008 p\0.01
Conclusion: Patients who undergo laparoscopic single-port roboticassisted gynecologic surgeries experience significantly less pain postoperatively as compared to patients undergoing multi-port gynecologic surgeries. In addition, estimated blood loss is significantly lower and length of stay is significantly shorter in patients undergoing single-port robotic-assisted procedures. Patient satisfaction scores appear to be higher in this group. Of note, the difference in pain and satisfaction scores may be even greater given that single-port surgery patients were evaluated more often on post-operative day 0 as opposed to post-operative day 1 for the majority of multi-port surgery patients. 177
Open Communications 14 - Laparoscopic Surgeries (11:00 AM - 12:00 PM) 11:21 AM – GROUP A
A Comparison Between Total Laparoscopic Hysterectomy and Abdominal Hysterectomy at TEC of Monterrey Healthcare System Basurto-Diaz D, Silva-Alanis J, Flores-Mendoza H, Hernandez-Nieto CA, Nungaray-Gonzalez L, Leyva-Gutierrez K, Garcia-Rodriguez LF. Tecnol ogico de Monterrey, San Pedro, Nuevo Leon, Mexico Study Objective: To compare variables regarding laparoscopic and abdominal hysterectomies. Design: A retrospective analysis of patients who underwent hysterectomy between 2007 and 2014 at TECSalud healthcare system was performed; 741 patients in the abdominal group and 206 in de laparoscopic group. Means, standard deviation and confidence intervals were calculated and a Student’s t-test was performed to test differences between means. Setting: TECSalud healthcare system. Patients: 741 patients in the abdominal group and 206 in de laparoscopic group. Intervention: Abdominal hysterectomy Total laparoscopic hysterectomy. Measurements and Main Results: Population characteristics were as follows for the laparoscopic group: age 45.84 years(SD=6.94), BMI 25.68(SD=5.39).Population characteristics for the abdominal group were: age 47.44 years(SD=7.57), BMI 24.60(SD=3.20), wound infections 113
178
Open Communications 14 - Laparoscopic Surgeries (11:00 AM - 12:00 PM) 11:32 AM – GROUP B
Jaffry AM,1 Hollenbeak CS.2 1Ob/Gyn, Hershey Medical Center, Hershey, Pennsylvania; 2Surgery and Public Health Sciences, Hershey Medical Center, Hershey, Pennsylvania Study Objective: To determine whether the route of hysterectomy has any significance in the rate of readmission within 30 days of surgery in Pennsylvania. Design: A retrospective cohort analysis to determine whether the minimally invasive approach had a lower rate of readmission after controlling for other patient characteristics. Age, race/ethnicity age, ethnicity, payer operation, admission status (elective, urgent, emergent) and admission type (transfer, referral) were the specific covariates that we used for control. Setting: Data for this study came from the Pennsylvania Health Care Cost Containment Council (PHC4). PHC4 is a state agency with the task of collection of data and reporting on outcomes of hospitals and health care providers across the state. The data set contained all the data from the UB-92 discharge form, including patient demographics, information about procedures, and discharge disposition. We identified hysterectomy procedures using ICD-9 procedure codes for non-radical open (68.31 68.39 68.4 68.49 689), laparoscopic (68.41, 68.51) and vaginal (68.51, 68.59) procedures. Patients: Our study looked at a large cohort of patients who have had a hysterectomy in 2011 in Pennsylvania. It included hysterectomies done for nonmalignant reasons in larger academic centers as well as smaller community hospitals. Intervention: A hysterectomy can be done vaginally, laparoscopically or with a laparotomy. Vaginal and laparoscopic routes are considered minimally invasive. Measurements and Main Results: A total of 15,869 hysterectomies were performed in 2011. There were 701 readmissions. 7,923 were laparotomies and out of these 439 were readmitted. 4,254 were vaginal hysterectomies and out of these 130 were readmitted. 3,692 were laparoscopic hysterectomies and out of these 132 were readmitted. Conclusion: Patients readmitted were mostly operated by low or medium volume surgeons, had a laparotomy, belonged to the black race and were either younger than 45 year or more than 65 years. Admission types, insurance types and hospital volumes were statistically insignificant. Table 1.
Readmitted Not Readmitted Total
Laparotomy N Percent
Vaginal N Percent
Laparoscopic N Percent
439 7,484 7,923
130 4,124 4,254
132 3,560 3,692
5.5 94.5 100.0
Readmission comparisons.
3.1 96.9 100.0
3.6 96.4 100.0
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Design: Prospective, case-cohort study. Setting: Large, suburban, academic/teaching hospital. Patients: Women undergoing robotic-assisted gynecologic procedures. Intervention: Analog pain and satisfaction surveys were evaluated in women undergoing laparoscopic single-port and multi-port roboticassisted hysterectomies and/or salpingo-oophorectomies. Patients received surveys on post-operative day 0 or 1, and at their two-week and six-week post-operative visits, with questions regarding post-operative pain, satisfaction with the surgery and incision appearance, etc.. Results were controlled for potential confounding variables such as pre-operative diagnosis, specimen weight, and patient demographics. Evaluation of preoperative pain, intra-operative estimated blood loss, and length of stay were also evaluated and compared between the two groups. Measurements and Main Results: Patients who underwent single-port laparoscopic surgery had a significantly lower estimated blood loss (65 mL versus 107 mL, p=0.035). They also had lower pain scores postoperatively (current pain - 2.1/10 versus 5.1/10, p=0.001, and maximum pain - 4.8/10 versus 7.1/10, p=0.008). Lastly, length of stay postoperatively was shorter for patients in the single-port compared to the multi-port group (0.67 days vs. 1.18 days, p = 0.01).
(SD=15.25; p=0.1144). There were no significant differences between characteristics of both groups. Laparoscopic hysterectomies had a significantly lower hospital-stay (2.62 vs 3.45; p=0.0001), significantly less bleeding (200.44 vs 291.98; p=0.0001). Nonetheless, they presented with a significantly higher surgical time (145.39 vs 123.52; p=0.0001). There were no differences in terms of complications between both groups and finally there was an increased risk of wound infection in the abdominal group (RR=1.42, p=0.1144). Conclusion: Evidence suggests that patients undergoing laparoscopic hysterectomy presented with lower hospital-stay and less bleeding in comparison with patients who underwent abdominal hysterectomy. Patients who underwent abdominal hysterectomy had a significantly lower surgical time but an increased risk of wound infections. Complications were equivalent in both groups. Therefore, total laparoscopic hysterectomy is a feasible and a safe option for hysterectomy in our population.
Single-Port vs Multi-Port Robotic Surgery Results
Route of Hysterectomy and Risk of Readmission
Uterine Weight (grams) Estimated Blood Loss (cc) Current Pain (POD 0/1) Maximum Pain (POD 0/1) Length of Stay (days)
Single-Port
Multi-Port
Significance
204 65.0 2.1 4.8 0.67
333 107.0 5.1 7.1 1.18
NS p\0.05 p\0.001 p=0.008 p\0.01
Conclusion: Patients who undergo laparoscopic single-port roboticassisted gynecologic surgeries experience significantly less pain postoperatively as compared to patients undergoing multi-port gynecologic surgeries. In addition, estimated blood loss is significantly lower and length of stay is significantly shorter in patients undergoing single-port robotic-assisted procedures. Patient satisfaction scores appear to be higher in this group. Of note, the difference in pain and satisfaction scores may be even greater given that single-port surgery patients were evaluated more often on post-operative day 0 as opposed to post-operative day 1 for the majority of multi-port surgery patients. 177
Open Communications 14 - Laparoscopic Surgeries (11:00 AM - 12:00 PM) 11:21 AM – GROUP A
A Comparison Between Total Laparoscopic Hysterectomy and Abdominal Hysterectomy at TEC of Monterrey Healthcare System Basurto-Diaz D, Silva-Alanis J, Flores-Mendoza H, Hernandez-Nieto CA, Nungaray-Gonzalez L, Leyva-Gutierrez K, Garcia-Rodriguez LF. Tecnol ogico de Monterrey, San Pedro, Nuevo Leon, Mexico Study Objective: To compare variables regarding laparoscopic and abdominal hysterectomies. Design: A retrospective analysis of patients who underwent hysterectomy between 2007 and 2014 at TECSalud healthcare system was performed; 741 patients in the abdominal group and 206 in de laparoscopic group. Means, standard deviation and confidence intervals were calculated and a Student’s t-test was performed to test differences between means. Setting: TECSalud healthcare system. Patients: 741 patients in the abdominal group and 206 in de laparoscopic group. Intervention: Abdominal hysterectomy Total laparoscopic hysterectomy. Measurements and Main Results: Population characteristics were as follows for the laparoscopic group: age 45.84 years(SD=6.94), BMI 25.68(SD=5.39).Population characteristics for the abdominal group were: age 47.44 years(SD=7.57), BMI 24.60(SD=3.20), wound infections 113
178
Open Communications 14 - Laparoscopic Surgeries (11:00 AM - 12:00 PM) 11:32 AM – GROUP B
Jaffry AM,1 Hollenbeak CS.2 1Ob/Gyn, Hershey Medical Center, Hershey, Pennsylvania; 2Surgery and Public Health Sciences, Hershey Medical Center, Hershey, Pennsylvania Study Objective: To determine whether the route of hysterectomy has any significance in the rate of readmission within 30 days of surgery in Pennsylvania. Design: A retrospective cohort analysis to determine whether the minimally invasive approach had a lower rate of readmission after controlling for other patient characteristics. Age, race/ethnicity age, ethnicity, payer operation, admission status (elective, urgent, emergent) and admission type (transfer, referral) were the specific covariates that we used for control. Setting: Data for this study came from the Pennsylvania Health Care Cost Containment Council (PHC4). PHC4 is a state agency with the task of collection of data and reporting on outcomes of hospitals and health care providers across the state. The data set contained all the data from the UB-92 discharge form, including patient demographics, information about procedures, and discharge disposition. We identified hysterectomy procedures using ICD-9 procedure codes for non-radical open (68.31 68.39 68.4 68.49 689), laparoscopic (68.41, 68.51) and vaginal (68.51, 68.59) procedures. Patients: Our study looked at a large cohort of patients who have had a hysterectomy in 2011 in Pennsylvania. It included hysterectomies done for nonmalignant reasons in larger academic centers as well as smaller community hospitals. Intervention: A hysterectomy can be done vaginally, laparoscopically or with a laparotomy. Vaginal and laparoscopic routes are considered minimally invasive. Measurements and Main Results: A total of 15,869 hysterectomies were performed in 2011. There were 701 readmissions. 7,923 were laparotomies and out of these 439 were readmitted. 4,254 were vaginal hysterectomies and out of these 130 were readmitted. 3,692 were laparoscopic hysterectomies and out of these 132 were readmitted. Conclusion: Patients readmitted were mostly operated by low or medium volume surgeons, had a laparotomy, belonged to the black race and were either younger than 45 year or more than 65 years. Admission types, insurance types and hospital volumes were statistically insignificant. Table 1.
Readmitted Not Readmitted Total
Laparotomy N Percent
Vaginal N Percent
Laparoscopic N Percent
439 7,484 7,923
130 4,124 4,254
132 3,560 3,692
5.5 94.5 100.0
Readmission comparisons.
3.1 96.9 100.0
3.6 96.4 100.0