Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse.
OBJECTIVE
Robot-assisted vaginal vault suspension (RAVVS) for pelvic organ prolapse (POP) represents a minimally-invasive alternative to abdominal sacrocolpopexy. We measured perioperative outcomes and utilization rates of RAVVS.


METHODS
RAVVS (n = 2381) and open VVS (OVVS, n = 11080) data were extracted from the 2009-2010 Nationwide Inpatient Sample. Propensity score-matched analysis compared patients undergoing RAVVS or OVVS for complications, mortality, prolonged length-of-stay, and elevated hospital charges.


RESULTS
Use of RAVVS for POP increased from 2009 to 2010 (16.3% to 19.2%). Patients undergoing RAVVS were more likely to be white (77.2% vs. 69.6%), to carry private insurance (52.8% vs. 46.0%) and to have fewer comorbidities (Charlson Comorbidity Index [CCI] ≥1 = 17.5% vs. 26.6%). They were more likely to undergo surgery at urban (98.2% vs. 93.7%) and academic centres (75.7% vs. 56.7%). Patients undergoing RAVVS were less likely to receive a blood-transfusion (0.7% vs. 1.8%, p < 0.001) or experience prolonged length-of-stay (9.3% vs. 25.1%, p < 0.001). They had more intraoperative complications (6.0% vs. 4.2%, p < 0.001), and higher median hospital charges ($32 402 vs. $24 136, p < 0.001). Overall postoperative complications were equivalent (17.9%, p = 1.0), though there were differences in wound (0.4% vs. 1.3%, p < 0.001), genitourinary (4.9% vs. 6.5%, p = 0.009), and surgical (6.6% vs. 4.9%, p = 0.007) complications.


CONCLUSIONS
The increasing use of RAVVS from 2009 to 2010 suggests a growth in the adoption of robotics to manage POP. We show that RAVVS is associated with decreased length of stay, fewer blood transfusions, as well as lower postoperative wound, genitourinary and vascular complications. The benefits of RAVVS are mitigated by higher hospital charges and higher rates of intra-operative complications.
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
Hanhan
H
Li
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
Jesse
J
Sammon
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC;
Florian
F
Roghmann
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
Akshay
A
Sood
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
Michael
M
Ehlert
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC;
Maxine
M
Sun
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
Mani
M
Menon
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
Humphrey
H
Atiemo
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; ; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC;
Quoc-Dien
QD
Trinh