title: Comparative effectiveness of robotically assisted compared with laparoscopic adnexal surgery for benign gynecologic disease.
abstract: OBJECTIVE
  To perform a population-based analysis to compare the complications and cost of laparoscopic and robotically assisted adnexal surgery.
  
  
  METHODS
  A nationwide database was used to analyze the use and outcomes of robotically assisted adnexal surgery from 2009 to 2012. Multivariable mixed effects regression models were developed to examine predictors of use of robotic surgery. After propensity score matching, complications and cost were compared between robotically assisted and laparoscopic surgery.
  
  
  RESULTS
  Eighty-seven thousand five hundred fourteen women were identified. From 2009 to 2012, performance of robotic-assisted oophorectomy increased from 3.5% (95% confidence interval [CI] 3.2-3.8%) to 15.0% (95% CI 14.4-15.6%), whereas robotically assisted cystectomy rose from 2.4% (95% CI 2.0-2.7%) to 12.9% (95% CI 12.2-13.5%). The overall complication rate was 7.1% (95% CI 4.0-10.2%) for robotically assisted compared with 6.0% (95% CI 2.9-9.1%) for laparoscopic oophorectomy (odds ratio [OR] 1.20, 95% CI 1.00-1.45; P=.052). Robotic-assisted oophorectomy was associated with a higher rate of intraoperative complications (3.4% compared with 2.1%, OR 1.60, 95% CI 1.21-2.13). The overall complication rate was 3.7% (95% CI -0.8 to 8.2%) after robotically assisted compared with 2.7% (95% CI -1.8 to 7.2%) for laparoscopic cystectomy (OR 1.38, 95% CI 0.95-1.99). The intraoperative complication rate was higher for robotically assisted cystectomy (2.0% compared with 0.9%, OR 2.40, 95% CI 1.31-4.38). Compared with laparoscopy, robotically assisted oophorectomy was associated with $2,504 (95% CI $2,356-2,652) increased total costs and robotically assisted cystectomy $3,310 (95% CI $3,082-3,581) higher costs.
  
  
  CONCLUSIONS
  Use of robotically assisted adnexal surgery increased rapidly. Compared with laparoscopic surgery, robotically assisted adnexal surgery is associated with substantially greater costs and a small, but statistically significant, increase in intraoperative complications.
authors.affiliation: Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Alessandra
authors.initials: A
authors.lastname: Kostolias
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.forename: Eri
authors.initials: E
authors.lastname: Prendergast
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010052:Ovariectomy / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012044:Regression Analysis; D012371:Robotics; D016896:Treatment Outcome; D014481:United States