title: Incorporating robotic-assisted surgery for endometrial cancer staging: Analysis of morbidity and costs.
abstract: To evaluate how the introduction of robotic-assisted surgery affects treatment-related morbidity and cost of endometrial cancer (EC) staging.
  
  
  
  We retrospectively reviewed the records of consecutive patients with stage I-III EC undergoing surgical staging between 2007 and 2012 at our institution. Costs (from surgery to 30days after surgery) were set based on the Medicare cost-to-charge ratio for each year and inflated to 2014 values. Inverse probability weighting (IPW) was used to decrease the allocation bias when comparing outcomes between surgical groups.
  
  
  
  We focused our analysis on the 251 EC patients who had robotic-assisted surgery and the 384 who had open staging. During the study period, the use of robotic-assisted surgery increased and open staging decreased (P<0.001). Correcting group imbalances by using IPW methodology, we observed that patients undergoing robotic-assisted staging had a significantly lower postoperative complication rate, lower blood transfusion rate, longer median operating time, shorter median length of stay, and lower readmission rate than patients undergoing open staging (all P<0.001). Overall 30-day costs were similar between the 2 groups, with robotic-assisted surgery having significantly higher median operating room costs ($2820 difference; P<0.001) but lower median room and board costs ($2929 difference; P<0.001) than open surgery. Increasing experience with robotic-assisted staging was significantly associated with a decrease in median operating time (P=0.002) and length of stay (P=0.003).
  
  
  
  The implementation of robotic-assisted surgery for EC staging improves patient outcomes. It provides women the benefits of minimally invasive surgery without increasing costs and potentially improves patient turnover.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Francesco
authors.initials: F
authors.lastname: Multinu
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Wilson
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Bobbie S
authors.initials: BS
authors.lastname: Gostout
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States.
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Killian
authors.affiliation: Strategy Access Solutions, San Carlos, CA, United States.
authors.forename: Akash
authors.initials: A
authors.lastname: Bijlani
authors.affiliation: Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Angioni
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: mariani.andrea@mayo.edu.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
mesh_terms: D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods; D058994:Salpingectomy / Q000379:methods; D014481:United States
keywords: Costs; Endometrial cancer; Lymphadenectomy; Robotic surgery