Outpatient Hysterectomy Volume in the United States

Cohen, Sarah L.; Ajao, Mobolaji O.; Clark, Nisse V.; Vitonis, Allison F.; Einarsson, Jon I.

doi:10.1097/aog.0000000000002103

Cited by 70 publications

(53 citation statements)

References 11 publications

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“…However, these studies were unable to capture the increasingly common outpatient hysterectomy. A recent cross-sectional study of State Ambulatory Surgery and Services Databases from 16 states for year 2011 estimated approximately 100,000–200,000 outpatient hysterectomies per year; approximately 81.5% performed laparoscopically and 16% vaginally [ 22 ]. To our knowledge, no previous study has examined trends in care setting over time.…”

Section: Introductionmentioning

confidence: 99%

Movement to outpatient hysterectomy for benign indications in the United States, 2008–2014

et al. 2017

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IntroductionThe past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS), alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH), as well as whether these trends exacerbate disparities.Materials and methodsRetrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR) using the most recent year of data (2014) to examine the influence of patient-, physician-, and hospital-level preoperative factors and surgical approaches on outpatient migration.ResultsFrom 2008–2014, surgical approaches for LH and RH increased, which coincided with decreases in VH and AH. Overall, a 44.2% shift was observed from inpatient to outpatient settings (P<0.0001). Among all outpatient visits MIS increased, particularly for RH (3.6% to 41.07%). We observed increases in the proportion of non-Hispanic Black and Medicaid patients who obtained MIS in 2014 vs. 2008 (P<0.001). Surgical approach (51.8%) and physician outpatient MIS experience (19.9%) had the greatest influence on predicting outpatient BH. Compared with LH, RH was associated with statistically significantly higher likelihood of outpatient BH overall (OR 1.23; 95% CI, 1.16–1.31), as well as in sub-analyses of more complex cases and hospitals that performed ≥1 RH (P<0.05).ConclusionFrom 2008–2014, rates of LH and RH significantly increased. A significant shift from inpatient to outpatient setting was observed. These findings suggest that RH may facilitate the shift to outpatient BH, particularly for patients with complexities. The adoption of MIS in outpatient settings may improve access to disadvantaged patient groups.

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Section: Introductionmentioning

confidence: 99%

Movement to outpatient hysterectomy for benign indications in the United States, 2008–2014

et al. 2017

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“…Hysterectomy is the most common procedure in gynecology. 1,2 Benign indications include symptomatic leiomyoma, abnormal uterine bleeding, endometriosis, adenomyosis, and pelvic organ prolapse. 3 Hysterectomy can be performed abdominally, vaginally, or laparoscopically; laparoscopic approaches include total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy, and robotic-assisted laparoscopic hysterectomy.…”

Section: Introductionmentioning

confidence: 99%

“…5 TLH and laparoscopic-assisted vaginal hysterectomy comprise 60% of hysterectomies in both inpatient and day-surgery settings 6 ; up to 82% of hysterectomies in an ambulatory setting may be performed laparoscopically. 2 The role of robotic-assisted hysterectomy is growing, accounting for 40%–45% of laparoscopic cases in 2012. 7…”

Section: Introductionmentioning

confidence: 99%

Single-Incision Hysterectomy Outcomes With and Without Robotic Assistance

Zhang

Kohn

Guan

2019

JSLS

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Objective:To evaluate the differences in operative time and postoperative complications for total laparoscopic hysterectomy (TLH) performed using conventional laparoendoscopic single-site surgery (LESS) versus a robotic-assisted LESS approach.Methods:A retrospective study was conducted of all cases of conventional LESS TLH (n = 47) and robotic LESS TLH (n = 129) for benign gynecologic conditions performed from November 2014 to October 2017. Patient characteristics, operative time for hysterectomy, estimated blood loss, duration of hospitalization, and short-term postoperative complications were compared using appropriate parametric and nonparametric statistical tests.Results:Conventional LESS TLH cases had a 16.36-minute longer mean operative time for hysterectomy (P < .01). No difference was found in uterine weight, estimated blood loss, hospitalization, or incidence of postoperative complications when LESS TLH was performed with or without robotic assistance. When comparing uterine weight < 100 g, conventional LESS TLH cases had significantly greater operative time than the robotic LESS TLH cases (78.10 ± 23.97 minutes vs. 59.97 ± 35.17 minutes, P < .01). When comparing uterine weight > 100 g, conventional LESS TLH cases again had significantly greater operative time than the robotic LESS TLH cases (98.73 ± 50.16 minutes vs. 80.00 ± 42.97 minutes, P < .01). There was no difference in postoperative complications.Conclusion:Robotic single-incision laparoscopy can result in decreased operative time compared to a conventional LESS approach. Robotic-assisted and conventional LESS are similar in rate of postoperative complications, if performed by surgeons with abundant LESS experience.

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“…Proponents suggest that ‘robots’ expand the spectrum of patients having access to minimally invasive surgery by allowing less skilled surgeons the opportunity to perform laparoscopic surgery. Indeed, the use of the da Vinci system has increased to the point that US gynaecologists perform 40–45% of their laparoscopic hysterectomies using this device, regardless of whether or not they are performed in an outpatient environment, an increasingly utilised approach, both in the US and elsewhere . Stockholders and executives of the companies making the devices have done well, but what about patients?…”

Section: Introductionmentioning

confidence: 99%

The surgical ‘Robot’ in gynaecology: It isn’t a robot at all, and it doesn’t make anything better

Munro

2018

Aust NZ J Obst Gynaeco

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Outpatient Hysterectomy Volume in the United States

Cited by 70 publications

References 11 publications

Movement to outpatient hysterectomy for benign indications in the United States, 2008–2014

Movement to outpatient hysterectomy for benign indications in the United States, 2008–2014

Single-Incision Hysterectomy Outcomes With and Without Robotic Assistance

The surgical ‘Robot’ in gynaecology: It isn’t a robot at all, and it doesn’t make anything better

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