Outside the operating room: How a robotics program changed resource utilization on the inpatient Ward.
To analyze the changes in the composition of the gynecologic oncology inpatient ward following the implementation of a robotic surgery program and its impact on inpatient resource utilization and costs.



Retrospective review of the medical charts of patients admitted onto the gynecologic oncology ward the year prior to and five years after the implementation of robotics. The following variables were collected: patient characteristics, hospitalization details (reason for admission and length of hospital stay), and resource utilization (number of hospitalization days, consultations, and imaging).



Following the introduction of robotic surgery, there were more admissions for elective surgery yet these accounted for only 21% of the inpatient ward in terms of number of hospital days, compared to 36% prior to the robotic program. This coincided with a sharp increase in the overall number of patients operated on by a minimally invasive approach (15% to 76%, p<0.0001). The cost per surgical admission on the inpatient ward decreased by 59% ($9827 vs. $4058) in the robotics era. The robotics program contributed to a ward with higher proportion of patients with complex comorbidities (Charlson≥5: RR 1.06), Stage IV disease (RR 1.30), and recurrent disease (RR 1.99).



Introduction of robotic surgery allowed for more patients to be treated surgically while simultaneously decreasing inpatient resource use. With more patients with non-surgical oncological issues and greater medical complexity, the gynecologic oncology ward functions more like a medical rather than surgical ward after the introduction of robotics, which has implications for hospital-wide resource planning.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Annie
A
Leung
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada; Division of Experimental Medicine, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Jeremie
J
Abitbol
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Agnihotram V
AV
Ramana-Kumar
Biomedical Engineering, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Bassam
B
Fadlallah
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Roy
R
Kessous
Department of Information Management, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Sabine
S
Cohen
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada; Department of Oncology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Susie
S
Lau
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada; Department of Oncology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada.
Shannon
S
Salvador
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada; Department of Oncology, Jewish General Hospital, Lady Davis Research Institute, McGill University, Montreal, QC H3T 1E2, Canada. Electronic address: walter.gotlieb@mcgill.ca.
Walter H
WH
Gotlieb
D000328:Adult; D000368:Aged; D001201:Ascites / Q000453:epidemiology; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging / Q000601:surgery*; D013509:Gynecologic Surgical Procedures; D006295:Health Resources; D017721:Hospital Costs / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000639:trends; D008875:Middle Aged; D010996:Pleural Effusion / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D049268:Positron-Emission Tomography / Q000191:economics / Q000639:trends; D011859:Radiography / Q000191:economics / Q000639:trends; D015642:Radiology, Interventional / Q000191:economics / Q000639:trends; D012017:Referral and Consultation / Q000191:economics / Q000639:trends*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D012371:Robotics; D018805:Sepsis / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000639:trends; D014552:Urinary Tract Infections / Q000453:epidemiology
Cost; Resource utilization; Robotics