RT Journal Article
SR Electronic
T1 The shift from inpatient to outpatient hysterectomy for endometrial cancer in the United States: trends, enabling factors, cost, and safety
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP 686
OP 693
DO 10.1136/ijgc-2020-002192
VO 31
IS 5
A1 Serena Cappuccio
A1 Yanli Li
A1 Chao Song
A1 Emeline Liu
A1 Gretchen Glaser
A1 Jvan Casarin
A1 Tommaso Grassi
A1 Kristina Butler
A1 Paul Magtibay
A1 Javier F Magrina
A1 Giovanni Scambia
A1 Andrea Mariani
A1 Carrie Langstraat
YR 2021
UL http://ijgc.bmj.com/content/31/5/686.abstract
AB 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.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.