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6: Comparison of robotic and other minimally-invasive routes of hysterectomy for benign indications
Oral Presentations treatment. Sixty-two percent (5/8) of the MBSR group practiced home meditation after the course, with the same number noting improvement in symptoms after a meditation session. All 8 participants said they would continue to incorporate MBSR in their care plans for IC/PBS. CONCLUSION: This trial provides initial evidence that MBSR is a promising adjunct therapy to treat IC/BPS. This study suggests that the benefit of this intervention may come from patients’ empowerment and ability to cope with symptoms. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Gregg Kanter: Nothing to disclose; Yuko Komesu: Nothing to disclose; Fares Qaedan: Nothing to disclose; Rebecca Rogers: American Medical Systems, DSMB Chair; UpToDate, Author, Royalties; McGraw Hill, Author, Royalties.
ajog.org hysterectomies performed using robotic-assistance ranged from 4345%, 10-13% for laparoscopy, and 19-24% for vaginal, with or without laparoscopy. A total of 1,338 women from each group were successfully matched using propensity score-matching. Roboticassisted hysterectomies had lower estimated blood loss (94.2 124.3 vs. 175.3 198.9 mL, p <.0001), longer surgical time (2.3 1.0 vs 2.0 1.0 hours, p<.0001) and larger specimen weights (178.9 186.3 vs 160.5 190 g, p <.0001) compared to other MIS routes (Table 1). Intraoperative bowel and bladder complications were similar between groups. Overall, the rate of any postoperative complication was lower with robotic-assisted versus other MIS hysterectomy routes (3.5% (n¼47) vs 5.6% (n¼75), p¼.01) and driven by lower rates of superficial SSI (0.07% (n¼1) vs 0.7% (n¼9), p ¼.01) and blood transfusion (0.8% (n¼11) vs 1.9% (n¼25), p¼.02). Readmission and reoperation rates did not differ between groups. Using hospital cost estimates from published data for different hysterectomy routes and considering the incremental costs associated with SSI and blood transfusion complications, non-robotic MIS routes had an average net savings of $3,519 per case, or 35% lower cost, compared to robotic-assisted hysterectomy ($9,910 vs $13,429). This calculation does not take into consideration purchase or maintenance cost of the robot. CONCLUSION: With the exception of superficial SSI and blood transfusion rates, complications, readmissions, and reoperations were similar for hysterectomies done for benign indications using robotic-assistance versus other MIS routes. In the absence of substantial reductions in clinically and financially burdensome complications, it will be challenging to find a scenario in which roboticassisted hysterectomy is cost-effective. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Carolyn W. Swenson: Nothing to disclose; Neil S. Kamdar: Nothing to disclose; Daniel M. Morgan: Nothing to disclose.
6 Comparison of robotic and other minimally-invasive routes of hysterectomy for benign indications C. W. Swenson, N. S. Kamdar, D. M. Morgan University of Michigan, Ann Arbor, MI
OBJECTIVES: To compare clinical outcomes and estimated cost of robotic-assisted hysterectomy to all other routes of minimallyinvasive hysterectomy for benign indications. MATERIALS AND METHODS: Data from a statewide database were used to analyze utilization and outcomes of minimally-invasive hysterectomy performed for benign indications from July 1, 2012 e July 1, 2014. Using a propensity score-match analysis to help control for demographic, clinical and hospital factors, a one-to-one match was performed between women who had a hysterectomy with roboticassistance versus other minimally-invasive (MIS) routes (laparoscopic and vaginal, with or without laparoscopy). Perioperative outcomes, intraoperative bowel and bladder injury, 30-day postoperative complications, readmissions and reoperations were compared between the propensity-matched cohorts. Cost estimates were derived from published data on hospital costs by hysterectomy route, surgical site infection (SSI) and postoperative blood transfusion. RESULTS: A total of 11,004 hysterectomy cases were identified: 6,222 performed using robotic-assistance and 4,782 performed using other MIS routes. During the study period, the proportion of
S458 American Journal of Obstetrics & Gynecology Supplement to APRIL 2016
ajog.org hysterectomies performed using robotic-assistance ranged from 4345%, 10-13% for laparoscopy, and 19-24% for vaginal, with or without laparoscopy. A total of 1,338 women from each group were successfully matched using propensity score-matching. Roboticassisted hysterectomies had lower estimated blood loss (94.2 124.3 vs. 175.3 198.9 mL, p <.0001), longer surgical time (2.3 1.0 vs 2.0 1.0 hours, p<.0001) and larger specimen weights (178.9 186.3 vs 160.5 190 g, p <.0001) compared to other MIS routes (Table 1). Intraoperative bowel and bladder complications were similar between groups. Overall, the rate of any postoperative complication was lower with robotic-assisted versus other MIS hysterectomy routes (3.5% (n¼47) vs 5.6% (n¼75), p¼.01) and driven by lower rates of superficial SSI (0.07% (n¼1) vs 0.7% (n¼9), p ¼.01) and blood transfusion (0.8% (n¼11) vs 1.9% (n¼25), p¼.02). Readmission and reoperation rates did not differ between groups. Using hospital cost estimates from published data for different hysterectomy routes and considering the incremental costs associated with SSI and blood transfusion complications, non-robotic MIS routes had an average net savings of $3,519 per case, or 35% lower cost, compared to robotic-assisted hysterectomy ($9,910 vs $13,429). This calculation does not take into consideration purchase or maintenance cost of the robot. CONCLUSION: With the exception of superficial SSI and blood transfusion rates, complications, readmissions, and reoperations were similar for hysterectomies done for benign indications using robotic-assistance versus other MIS routes. In the absence of substantial reductions in clinically and financially burdensome complications, it will be challenging to find a scenario in which roboticassisted hysterectomy is cost-effective. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Carolyn W. Swenson: Nothing to disclose; Neil S. Kamdar: Nothing to disclose; Daniel M. Morgan: Nothing to disclose.
6 Comparison of robotic and other minimally-invasive routes of hysterectomy for benign indications C. W. Swenson, N. S. Kamdar, D. M. Morgan University of Michigan, Ann Arbor, MI
OBJECTIVES: To compare clinical outcomes and estimated cost of robotic-assisted hysterectomy to all other routes of minimallyinvasive hysterectomy for benign indications. MATERIALS AND METHODS: Data from a statewide database were used to analyze utilization and outcomes of minimally-invasive hysterectomy performed for benign indications from July 1, 2012 e July 1, 2014. Using a propensity score-match analysis to help control for demographic, clinical and hospital factors, a one-to-one match was performed between women who had a hysterectomy with roboticassistance versus other minimally-invasive (MIS) routes (laparoscopic and vaginal, with or without laparoscopy). Perioperative outcomes, intraoperative bowel and bladder injury, 30-day postoperative complications, readmissions and reoperations were compared between the propensity-matched cohorts. Cost estimates were derived from published data on hospital costs by hysterectomy route, surgical site infection (SSI) and postoperative blood transfusion. RESULTS: A total of 11,004 hysterectomy cases were identified: 6,222 performed using robotic-assistance and 4,782 performed using other MIS routes. During the study period, the proportion of
S458 American Journal of Obstetrics & Gynecology Supplement to APRIL 2016