title: Comparison of cost and operative outcomes of robotic hysterectomy compared to laparoscopic hysterectomy across different uterine weights.
abstract: Operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights. Retrospective cohort study including patients undergoing robotic and laparoscopic hysterectomy for benign disease at an Academic university hospital. One hundred and ninety six hysterectomies were identified (101 robotic versus 95 laparoscopic). Demographic and surgical characteristics were statistically equivalent. Robotic group had a higher body mass index (±SD) (32.9 ± 6.5 versus 30.4 ± 7.1, p 0.012) and more frequent history of adnexal surgery (12.9 versus 4.2%, p 0.031). Laparoscopic group had a higher number of concurrent salpingectomy (81 versus 66.3%, p 0.02). Estimated blood loss did not differ between procedures. Compared to robotic hysterectomies, laparoscopic procedures added 47 min (CI: 31-63 min; p < 0.001) of operative time, costed $1648 more (CI: 500-2797; p = 0. 005) and had triple the odds of having an overnight admission (OR = 2.94 CI: 1.34-6.44; p = 0.007). After stratification of cases by uterine weight, the mean operative time difference between the two groups in uteri between 750 and 1000 g and in uteri >1000 g was 81.3 min (CI: 51.3-111.3, p < 0.0001) and 70 min (CI: 26-114, p < 0.005), respectively, in favor of the robotic group. Mean direct cost difference in uteri between 750 and 1000 g and uteri >1000 g was 1859$ (CI: 629-3090, p < 0.006) and 4509$ (CI: 377-8641, p < 0.004), respectively, also in favor of the robotic group. In expert hands, robotic hysterectomy for uteri weighing more than 750 g may be associated with shorter operative time and improved cost profile.
authors.affiliation: Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA.
authors.forename: Gaby N
authors.initials: GN
authors.lastname: Moawad
authors.affiliation: Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA. eliasabikhalil84@gmail.com.
authors.forename: Elias D
authors.initials: ED
authors.lastname: Abi Khalil
authors.affiliation: Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Tyan
authors.affiliation: George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Shu
authors.affiliation: George Washington University School of Medicine, Washington, DC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Samuel
authors.affiliation: Department of Surgery, George Washington University Hospital, Washington, DC, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Amdur
authors.affiliation: Department of Obstetrics & Gynecology, Johns Hopkins Hospital, Washington, DC, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Scheib
authors.affiliation: Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA.
authors.forename: Cherie Q
authors.initials: CQ
authors.lastname: Marfori
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology* / Q000601:surgery
keywords: Cost; Hysterectomy; Laparoscopic; Operative outcomes; Robotic