Objective To evaluate trends in outpatient versus inpatient hysterectomy for endometrial cancer and assess enabling factors, cost and safety.
Methods In this retrospective cohort study, patients aged 18 years or older who underwent hysterectomy for endometrial cancer between January 2008 and September 2015 were identified in the Premier Healthcare Database. The surgical approach for hysterectomy was classified as open/abdominal, vaginal, laparoscopic or robotic assisted. We described trends in surgical setting, perioperative costs and safety. The impact of patient, provider and hospital characteristics on outpatient migration was assessed using multivariate logistic regression.
Results We identified 41 246 patients who met inclusion criteria. During the time period studied, we observed a 41.3% shift from inpatient to outpatient hysterectomy (p<0.0001), an increase in robotic hysterectomy, and a decrease in abdominal hysterectomy. The robotic hysterectomy approach, more recent procedure (year), and mid-sized hospital were factors that enabled outpatient hysterectomies; while abdominal hysterectomy, older age, Medicare insurance, black ethnicity, higher number of comorbidities, and concomitant procedures were associated with an inpatient setting. The shift towards outpatient hysterectomy led to a $2500 savings per case during the study period, in parallel to the increased robotic hysterectomy rates (p<0.001). The post-discharge 30-day readmission and complications rate after outpatient hysterectomy remained stable at around 2%.
Conclusions A significant shift from inpatient to outpatient setting was observed for hysterectomies performed for endometrial cancer over time. Minimally invasive surgery, particularly the robotic approach, facilitated this migration, preserving clinical outcomes and leading to reduction in costs.
- endometrial neoplasms
- surgical oncology
- postoperative complications
- gynecologic Surgical Procedures
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Contributors SC, CL, AM, YL: Study concept, data analysis and writing of the manuscript. CS: Study concept, review and revision of the manuscript. EL: Study concept, overseeing of study conduct, review and revision of the manuscript. JC, GG, GS, JFM, PM, KB, TG: revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests CS reports personal fees from Intuitive Surgical, outside the submitted work. YL is a full-time employee and stock holder of Intuitive Surgical.
Patient consent for publication Not required.
Ethics approval As this was a retrospective, observational study using de-identified patient data in the PHD, it is fully compliant with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, and was deemed exempt from Institutional Review Board approval.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from Premier Inc. Restrictions apply to the availability of these data, which were used under license for this study.
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