title: Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients - a comparative analysis of total charges and complication rates.
abstract: OBJECTIVE
  To compare the complications and charges of robotic vs. laparoscopic vs. open surgeries in morbidly obese patients treated for endometrial cancer.
  
  
  METHODS
  Data were obtained from the Nationwide Inpatient Sample from 2011. Chi-squared, Wilcoxon rank sum two-sample tests, and multivariate analyses were used for statistical analyses.
  
  
  RESULTS
  Of 1087 morbidly obese (BMI ≥40kg/m(2)) endometrial cancer patients (median age: 59years, range: 22 to 89), 567 (52%) had open surgery (OS), 98 (9%) laparoscopic (LS), and 422 (39%) robotic surgery (RS). 23% of OS, 13% of LS, and 8% of RS patients experienced an intraoperative or postoperative complication including: blood transfusions, mechanical ventilation, urinary tract injury, gastrointestinal injury, wound debridement, infection, venous thromboembolism, and lymphedema (p<0.0001). RS and LS patients were less likely to receive blood transfusions compared to OS (5% and 6% vs. 14%, respectively; p<0.0001). The median lengths of hospitalization for OS, LS, and RS patients were 4, 1, and 1days, respectively (p<0.0001). Median total charges associated with OS, LS, and RS were $39,281, $40,997, and $45,030 (p=0.037), respectively.
  
  
  CONCLUSIONS
  In morbidly obese endometrial cancer patients, minimally invasive robotic or laparoscopic surgeries were associated with fewer complications and less days of hospitalization relative to open surgery. Compared to laparoscopic approach, robotic surgeries had comparable rates of complications but higher charges.
authors.affiliation: Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, United States. Electronic address: chanjohn@sutterhealth.org.
authors.forename: John K
authors.initials: JK
authors.lastname: Chan
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States.
authors.forename: Austin B
authors.initials: AB
authors.lastname: Gardner
authors.affiliation: Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, United States.
authors.forename: Katie
authors.initials: K
authors.lastname: Taylor
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States; Department of Epidemiology and Biostatistics, College of Public Health, San Diego State University, San Diego, CA, United States.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States.
authors.forename: Kevin
authors.initials: K
authors.lastname: Blansit
authors.affiliation: Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Kapp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016889:Endometrial Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D041981:Gastrointestinal Tract / Q000293:injuries; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008209:Lymphedema / Q000453:epidemiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics*; D013530:Surgical Wound Infection / Q000453:epidemiology; D014551:Urinary Tract / Q000293:injuries; D055815:Young Adult
keywords: Endometrial cancer; Hospital charges; Laparoscopic surgery; Morbid obesity; Robotic surgery; Surgical complications