Clinical and Economic Burden of Surgical Site Infection in Hysterectomy

Roy, Sanjoy; Patkar, Anuprita; Daskiran, Mehmet; Levine, Roger; Hinoul, Piet; Nigam, Somesh

doi:10.1089/sur.2012.163

Cited by 40 publications

(24 citation statements)

References 11 publications

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“…Roy et al performed an analysis on the prevalence and impact of SSI after hysterectomy and found that SSI doubles the cost of hysterectomy. 19 Finally, Shander et al performed an analysis of the cost of blood transfusion in post-surgical patients that incorporated both direct and indirect costs and determined the mean per-red blood cell (RBC)-unit cost to be $761. 20 Using these cost estimates and considering the incremental costs associated with SSI and blood transfusion complications (assuming transfusion of 2 units of RBCs), non-robotic MIS routes had an average net savings of $3,269 per case, or 24% lower cost, compared to robotic-assisted hysterectomy ($10,160 vs $13,429; see Appendix for equation).…”

Section: Resultsmentioning

confidence: 99%

Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications

Swenson

Kamdar

Harris

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Despite a lack of evidence showing improved clinical outcomes with robotic-assisted hysterectomy over other minimally-invasive routes for benign indications, this route has increased in popularity over the last decade. Objective Compare clinical outcomes and estimated cost of robotic-assisted versus other routes of minimally-invasive hysterectomy for benign indications. Study Design A statewide database was used to analyze utilization and outcomes of minimally-invasive hysterectomy performed for benign indications from January 1, 2013 – July 1, 2014. A one-to-one propensity score-match analysis was performed between women who had a hysterectomy with robotic assistance versus other minimally-invasive routes (laparoscopic and vaginal, with or without laparoscopy). Perioperative outcomes, intraoperative bowel and bladder injury, 30-day postoperative complications, readmissions, and reoperations were compared. Cost estimates of hysterectomy routes, surgical site infection, and postoperative blood transfusion were derived from published data. Results 8,313 hysterectomy cases were identified: 4,527 performed using robotic-assistance and 3,786 performed using other minimally-invasive routes. 1,338 women from each group were successfully matched using propensity score-matching. Robotic-assisted hysterectomies had lower estimated blood loss (94.2 ±124.3 vs. 175.3 ±198.9 mL, p <.001), longer surgical time (2.3 ± 1.0 vs 2.0 ± 1.0 hours, p<.001), larger specimen weights (178.9 ± 186.3 vs 160.5 ± 190 g, p =.007) and shorter length of stay (14.1% (189) vs 21.9% (293) ≥ 2 days, p<.001). Overall, the rate of any postoperative complication was lower with the robotic-assisted route (3.5% (47) vs 5.6% (75), p=.01) and driven by lower rates of superficial SSI (0.07% (1) vs 0.7% (9), p =.01) and blood transfusion (0.8% (11) vs 1.9% (25), p=.02). Major postoperative complications, intraoperative bowel and bladder injury, readmissions, and reoperations were similar between groups. Using hospital cost estimates of hysterectomy routes and considering the incremental costs associated with surgical site infections and blood transfusions, non-robotic minimally-invasive routes had an average net savings of $3,269 per case, or 24% lower cost, compared to robotic-assisted hysterectomy ($10, 160 vs $13,429). Conclusions Robotic-assisted laparoscopy does not decrease major morbidity following hysterectomy for benign indications when compared to other minimally-invasive routes. While superficial surgical site infection and blood transfusion rates were statistically lower in the robotic-assisted group, in the absence of substantial reductions in clinically and financially burdensome complications, it will be challenging to find a scenario in which robotic-assisted hysterectomy is clinically superior and cost-effective.

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Section: Resultsmentioning

confidence: 99%

Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications

Swenson

Kamdar

Harris

et al. 2016

American Journal of Obstetrics and Gynecology

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“…Gynaecologists have been using the vagina in vaginal hysterectomies for many years, and the report of infections is very low. In a recent multi-institutional study that analysed surgical side infection in more than 220,000 hysterectomies, the vaginal approach, both laparoscopic and non-laparoscopic, represented 45 % of all hysterectomies and had an incidence of surgical infection of 0.2 % [7]. In living donation, the transvaginal approach is an interesting option, because roughly two of the three of donors are women.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcome and female sexual function after laparoscopic transvaginal NOTES-assisted nephrectomy

et al. 2015

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“…8 In endometrial cancer patients, SSIs accounted for a $5447 median increase in the 30-day cost of care. [11][12][13] In addition to the economic drivers of a health care system, measures of SSIs are being included among the metrics used to evaluate quality of the care individual physicians and hospitals provide to their patients. 10 In these ways, SSIs potentially redirect resources from other areas of the health care system.…”

mentioning

confidence: 99%