Minimizing pain medication use and its associated costs following robotic surgery

Abitbol, Jeremie; Cohn, Rebecca; Hunter, S. J.; Rombaldi, Marcelo Costamilan; Cohen, E.J.; Kessous, Roy; Large, Nick; Reiss, Ari; Salvador, Shannon

doi:10.1016/j.ygyno.2016.11.014

Cited by 14 publications

(5 citation statements)

References 17 publications

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“…Though novel, our findings are consistent with previous findings of decreased perioperative analgesia requirements, and quicker recuperation afforded by MIS [17,18]. Therefore, the increased perioperative costs of MIS, including robotic surgery may be offset by long-term advantages such as quicker return to work and decreased opioid utilization [19,20].…”

Section: Discussionsupporting

confidence: 89%

Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures

et al. 2020

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Background The rise in deaths attributed to opioid drugs has become a major public health problem in the United States and in the world. Minimally invasive surgery (MIS) is associated with a faster postoperative recovery and our aim was to investigate if the use of MIS was associated with lower odds of prolonged opioid prescriptions after major procedures. Methods Retrospective study using the IBM Watson Health Marketscan® Commerical Claims and Encounters Database investigating opioid-naïve cancer patients aged 18–64 who underwent open versus MIS radical prostatectomy (RP), partial colectomy (PC) or hysterectomy (HYS) from 2012 to 2017. Propensity weighted logistic regression analyses were used to estimate the independent effect of surgical approach on prolonged opioid prescriptions, defined as prescriptions within 91–180 days of surgery. Results Overall, 6838 patients underwent RP (MIS 85.5%), 4480 patients underwent PC (MIS 61.6%) and 1620 patients underwent HYS (MIS 41.8%). Approximately 70–80% of all patients had perioperative opioid prescriptions. In the weighted model, patients undergoing MIS were significantly less likely to have prolonged opioid prescriptions in all three surgery types (Odds Ratio [OR] 0.737, 95% Confidence Interval [CI] 0.595–0.914, p = 0.006; OR 0.728, 95% CI 0.600–0.882, p = 0.001; OR 0.655, 95% CI 0.466–0.920, p = 0.015, respectively). Conclusion The use of the MIS was associated with lower odds of prolonged opioid prescription in all procedures examined. While additional studies such as clinical trials are needed for further confirmation, our findings need to be considered for patient counseling as postoperative differences between approaches do exist.

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Section: Discussionsupporting

confidence: 89%

Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures

et al. 2020

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“…MIS approaches were also associated with a reduced duration of hospital stay, which relates to reduced health service costs. Our findings are consistent with the Cochrane review [7] on LRS for EC and large RCTs such as LACE [21] and LAP2 [22]. OS was associated with a higher incidence of post-operative complications such as Fever, infection and ileus compared with MIS.…”

Section: Comparison With Existing Literaturesupporting

confidence: 89%

Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis

Natarajan,

Delanerolle,

Dobson

et al. 2024

Cancers

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Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies. Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995–31 December 2021. A Bayesian network meta-analysis was conducted. Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reduced blood loss and length of hospital stay but increased operating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction in ileus (OR = 0.40, 95% CrI: 0.17–0.87) and total intra-operative complications (OR = 0.38, 95% CrI: 0.17–0.75) as well as a higher disease-free survival (OR = 2.45, 95% CrI: 1.04–6.34). Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.

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“…Together with total laparoscopic hysterectomy (TLH), laparoscopic‐assisted vaginal hysterectomy (LAVH), vaginal hysterectomy and laparoscopic supracervical hysterectomy, the increase in robotic hysterectomy has resulted in the decrease of abdominal hysterectomy to approximately 28% 2 . Since its approval by the FDA for benign gynaecology in 2005, scores of studies and publications have assessed the clinical and economic strengths and weaknesses of the Intuitive Surgical da Vinci robot's use in benign hysterectomy, with the vast majority of studies underscoring robotic surgery as generally equivalent clinically to laparoscopy together with some reports of reduced pain, less blood loss, and shorter length of stay albeit with generally higher cost and longer operative times, though this variable may also be dependent on patient characteristics and comorbidities 3–5 …”

Section: Introductionmentioning

confidence: 99%

Senhance surgical system in benign hysterectomy: A real‐world comparative assessment of case times and instrument costs versus da Vinci robotics and laparoscopic‐assisted vaginal hysterectomy procedures

Coussons¹,

Feldstein²,

McCarus

2021

Robotics Computer Surgery

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Objectives Comparison of retrospective, learning curve benign hysterectomy cost and case time data from Senhance total laparoscopic hysterectomy (TLH) cases with similar da Vinci robot cases and laparoscopic‐assisted vaginal hysterectomy (LAVH) cases. Methods Instrument costs, console time, and case time analysis from six surgeons at four U.S. and European hospitals compared with retrospective, sequential da Vinci TLH and standard laparoscopic LAVH cases extracted from the CAVAlytics database. Results Senhance Gyn surgeons in their learning curve when compared to da Vinci learning curve Gyn surgeons achieved lower median instrument costs ($559 vs. $1393, respectively, p < 0.001) with comparable console times (91.5 vs. 96 min, p = 0.898); Senhance and LAVH case costs were comparable ($559 vs. $498, p = 0.336). Conclusion In benign hysterectomy, the Senhance system may present a lower‐cost approach with equivalent case times compared with similar da Vinci robotic cases.

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Minimizing pain medication use and its associated costs following robotic surgery

Cited by 14 publications

References 17 publications

Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures

Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures

Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis

Senhance surgical system in benign hysterectomy: A real‐world comparative assessment of case times and instrument costs versus da Vinci robotics and laparoscopic‐assisted vaginal hysterectomy procedures

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