title: Hospital Revisits Within 30 Days After Conventional and Robotically Assisted Hysterectomy.
abstract: OBJECTIVE
  To compare the rates of hospital readmissions, emergency department, and outpatient clinic visits after discharge for robotically assisted (RA) versus nonrobotic hysterectomy in women age 30 or more with nonmalignant conditions.
  
  
  METHODS
  Discharges for 2011 for 8 states (CA, FL, GA, IA, MO, NE, NY, TN) (>86,000 inpatient hysterectomies) were drawn from the statewide databases of the Healthcare Cost and Utilization Project. Data from 4 of these states were used to study revisits after 29,000 outpatient hysterectomies.
  
  
  METHODS
  Matched pairs of patients were constructed with propensity scores derived from each patient's age group, severity of illness, insurance coverage, and type of procedure. Both the full set of revisits and a set limited to diagnoses for revisits judged in other research to be related to the initial surgery (about 70% of all revisits) were analyzed. The analyses were repeated with an instrumental variables regression design.
  
  
  RESULTS
  Using the propensity score matched pairs, revisits, and specifically readmissions, after inpatient hysterectomy were greater for RA versus non-RA patients (relative risk of readmission=124%, P<0.01). Similar results were found for readmissions after outpatient hysterectomy, and readmissions after inpatient hysterectomy for the restricted set of related revisits. In the method with instrumental variables, RA was associated with an increase of 32% in the likelihood of any revisit (P<0.01).
  
  
  CONCLUSIONS
  Using 2 different methods to control for selection, this study found higher rates of revisits among women undergoing RA versus non-RA hysterectomy for benign conditions. While selection bias cannot be ruled out completely in an observational study, the study supports broader use of revisits for analyses of outcomes of hysterectomy.
authors.affiliation: *Agency for Healthcare Research and Quality, Rockville, MD †Tel Aviv Sourasky Medical Center and Weitzmann Institute of Science, Rehovot, Israel ‡Wagner School of Public Service, New York University, New York, NY.
authors.forename: Bernard
authors.initials: B
authors.lastname: Friedman
authors.forename: Gabriel I
authors.initials: GI
authors.lastname: Barbash
authors.forename: Sherry A
authors.initials: SA
authors.lastname: Glied
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D057216:Propensity Score; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014481:United States