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Na J, Chung YE, Jang IY, Lee YY, Kim TJ, Lee JW, Kim BG, Chang CS, Choi CH. Advantages of laparoscopy in gynecologic surgery in elderly patients. Obstet Gynecol Sci 2024; 67:243-252. [PMID: 38053014 PMCID: PMC10948208 DOI: 10.5468/ogs.23238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years. METHODS We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type. RESULTS Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar restuls were observed in cancer-only and benign-only cohorts. CONCLUSION Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.
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Affiliation(s)
- Jaewon Na
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Young Eun Chung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Il-Yeo Jang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Chi-Son Chang
- Department of Obstetrics and Gynecology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong,
Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
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Moore MS, Vo EH, Bhattarai B, Farley JH, Monk BJ, Willmott LJ, Chase DM. Robotic-assisted gynecologic surgery in an older population: A comparison study. J Geriatr Oncol 2023; 14:101533. [PMID: 37295288 DOI: 10.1016/j.jgo.2023.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/04/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Robotic-assisted surgery in select patients has been shown to result in less peri-operative morbidity. Few studies have explored the association of robotic-assisted gynecology oncology surgery complication rates and increasing age. Our objective was to evaluate the peri- and postoperative complication rates in patients age 65 years or above in minimally-invasive robotic gynecologic surgery. MATERIAL AND METHODS We performed a retrospective review of data from 765 consecutive minimally-invasive robotic-assisted surgeries performed by high-volume gynecologic oncologists. The patients were divided into "younger" patients aged <65 years and "older" patients aged ≥65 years. The primary outcomes were intraoperative and postoperative complications. RESULTS Of the 765 patients analyzed, 185 (24%) were ≥ 65. The intraoperative complication rate in patients <65 was 1.9% (11/580) versus 1.62% (3/185) in females ≥65 (p = 0.808). The postoperative complication rate in patients <65 was 15.5% (90/580) versus 22.7% (42/185) in females ≥65 (p = 0.328). We observed more post-operative complications with patients who had intraoperative complications compared to patients who developed post-operative complications without intraoperative complcations in our sample, but it was not statisticaly significant (OR = 2.78, p = 0.097). The average estimated blood loss was 137.5 ml (0-1000) for patients younger than 65 years and 134.81 ml (0-2200) in patients 65 years or older (p = 0.097). DISCUSSION Robotic gynecologic oncology surgery is common. When performed by expert surgeons, complications are not associated with increasing age.
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Affiliation(s)
- Madison S Moore
- Arizona Oncology (US Oncology Network), Phoenix, AZ, United States of America
| | - Elise H Vo
- Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Bikash Bhattarai
- Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America; Maricopa Integrated Health System, Phoenix, AZ, United States of America
| | - John H Farley
- The University of Arizona College of Medicine, Phoenix, AZ, United States of America; Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Bradley J Monk
- The University of Arizona College of Medicine, Phoenix, AZ, United States of America; Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America; Maricopa Integrated Health System, Phoenix, AZ, United States of America; HonorHealth Research Institute, Phoenix, AZ, United States of America
| | - Lyndsay J Willmott
- The University of Arizona College of Medicine, Phoenix, AZ, United States of America; Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America; Maricopa Integrated Health System, Phoenix, AZ, United States of America; Arizona Center for Cancer Care (Virginia Piper Cancer Care Network), Phoenix, AZ, United States of America
| | - Dana M Chase
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
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Nelson G, Fotopoulou C, Taylor J, Glaser G, Bakkum-Gamez J, Meyer LA, Stone R, Mena G, Elias KM, Altman AD, Bisch SP, Ramirez PT, Dowdy SC. Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update. Gynecol Oncol 2023; 173:58-67. [PMID: 37086524 DOI: 10.1016/j.ygyno.2023.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges. METHODS Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.
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Affiliation(s)
- G Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - C Fotopoulou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - J Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - J Bakkum-Gamez
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - L A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Stone
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Mena
- Department of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - A D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S P Bisch
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - P T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - S C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Lees BF, Johnson S, Donahue E, Bose R, Brown J, Crane E, Puechl A, Tait D, Naumann RW. Improved Rates of Same-day Discharge in Patients Undergoing Surgery for Endometrial Cancer Following the COVID-19 Pandemic. J Minim Invasive Gynecol 2022; 29:1248-1252. [PMID: 35940525 PMCID: PMC9354383 DOI: 10.1016/j.jmig.2022.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To determine the effect of the coronavirus disease 2019 (COVID-19) pandemic on the rate of same-day discharge (SDD) after minimally invasive surgery for endometrial cancer. DESIGN Retrospective cohort. SETTING Teaching hospital. PATIENTS A total of 166 patients underwent a minimally invasive surgery procedure for the indication of endometrial cancer at a large academic institution from September 1, 2019, to October 1, 2020-80 patients before the implementation of the COVID-19 restrictions and 86 patients after. INTERVENTIONS COVID-19 pandemic with visitor restrictions and hospital policy changes placed on March 17, 2020. MEASUREMENTS AND MAIN RESULTS SDD rate was increased by 18% after the start of the COVID-19 pandemic (40% vs 58%, p = .02). There were no differences between the 2 groups with regard to operative time (p = .07), estimated blood loss (p = .21), uterine weight (p = .12), age (p = .06), body mass index (p = .42), or surgery start time (p = .15). In a multivariable logistic regression model, subjects in the COVID-19 group had 3.08 times (95% confidence interval, 1.40-6.74; p = .01) higher odds of SDD than those in the pre-COVID-19 group. There was no difference in 30-day readmission rates (7.5% vs 5.8%, p = .66). CONCLUSION There was a significant increase in the SDD of patients with endometrial cancer since the start of the COVID-19 pandemic. The pandemic has strained hospital resources and motivated patients and physicians to avoid hospitalization. This shows that with proper motivation, an increase in SDD rates is possible without an increase in complications or rehospitalization.
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Affiliation(s)
- Brittany F. Lees
- Corresponding author: Brittany F. Lees, MD, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Dr, Ste 2100, Charlotte, NC 28204
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Kurt G, Guvenc G, Dede M, Yenen MC, Akyuz A. Comparison of health-related quality of life of women undergoing robotic surgery, laparoscopic surgery or laparotomy for gynecologic conditions: A cross-sectional study. Int J Gynaecol Obstet 2022; 159:583-591. [PMID: 35396864 DOI: 10.1002/ijgo.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess and compare the health-related quality of life of women undergoing robotic gynecologic surgery, laparoscopic gynecologic surgery or laparotomy for benign and cancerous conditions. METHODS Cross-sectional study design was used. The present study was carried out with 240 women, who underwent gynecologic surgery (robotic 48, laparoscopic 96, and laparotomy 96) in a tertiary care hospital. Instruments included a participant description questionnaire and Medical Outcomes Study Short Form-36. The data were collected 4 weeks after surgery, at the first postoperative visit of women to the clinic. Pearson χ2 test, one-way analysis of variance, and regression analysis were used to assess the data. RESULTS Over half of the women in each group had surgery because of gynecologic cancer. All the subscale scores of Medical Outcomes Study Short Form-36 were significantly higher in the robotic group than the other surgical groups (P < 0.05). Women in the robotic group had better quality of life in terms of both the physical component and the mental component after surgery. CONCLUSIONS Knowledge of health-related quality of life in the recovery period after surgery is important for healthcare providers to provide adequate preventive measures, information, and follow up.
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Affiliation(s)
- Gonul Kurt
- Department of Obstetrics and Gynecology Nursing, University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Turkey
| | - Gulten Guvenc
- Department of Obstetrics and Gynecology Nursing, University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Turkey
| | - Murat Dede
- Department of Gynecology and Obstetrics, Anatolia Health Center, Kocaeli, Turkey
| | - Mufit Cemal Yenen
- Department of Gynecology and Obstetrics, University of Kyrenia Hospital, Kyrenia, Cyprus
| | - Aygul Akyuz
- Department of Obstetrics and Gynecology Nursing, Demiroglu Bilim University Florence Nightingale Hospital School of Nursing, Istanbul, Turkey
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Lee SS, Chern JY, Frey MK, Comfort A, Lee J, Roselli N, Boyd LR. Enhanced recovery Pathways in gynecologic surgery: Are they safe and effective in the elderly? Gynecol Oncol Rep 2021; 38:100862. [PMID: 34621945 PMCID: PMC8479239 DOI: 10.1016/j.gore.2021.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare perioperative outcomes of the elderly versus non-elderly patients on ERPs undergoing laparotomy for gynecologic surgery. METHODS From January 2016 to June 2017, patients undergoing elective laparotomies for gynecologic surgery were enrolled in a perioperative ERP protocol. Outcomes were compared between the elderly (age ≥ 70 years) and the non-elderly (age ≤ 69 years). Primary outcomes were length of stay and perioperative complication rates. Comparisons were performed using chi-squared tests or Fisher's exact tests for categorical data and Student's t-test or Wilcoxon rank-sum tests for continuous variables, with p < 0.05 for significance. RESULTS One hundred eighty-nine patients were enrolled in the study, including 16 patients ≥ 70 years old. The median age was 75 years for the elderly and 45 years for the non-elderly. Elderly patients were more likely to have more complex surgery and longer operative times (absolute median difference of 39 min). Despite the increasing complexity of surgical procedures for elderly patients, there were no statistically significant differences in serious inpatient complications (Clavien-Dindo score 3A or greater), pain and nausea scores, 30-day complications and readmission rates. Elderly patients had a longer median length of stay compared to non-elderly patients by one day (p < 0.001), however, this was not statistically significant on multivariate analysis. CONCLUSION In our series, elderly patients on the ERP had similar rates of complications and readmission when compared to non-elderly patients, despite undergoing more complex surgeries. This suggests that ERP may be feasible and safe in the elderly population undergoing elective gynecologic laparotomy.
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Affiliation(s)
- Sarah S. Lee
- New York University School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York, NY, United States
| | - Jing-Yi Chern
- Moffitt Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tampa, FL, United States
| | - Melissa K. Frey
- Weill Cornell Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York, NY, United States
| | - Ashley Comfort
- Boston University Medical Center, Department of Obstetrics and Gynecology, Boston, MA, United States
| | - Jessica Lee
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Dallas, TX, United States
| | - Nicole Roselli
- New York University School of Medicine, Department of Obstetrics and Gynecology
| | - Leslie R. Boyd
- New York University School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York, NY, United States
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7
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Corrado G, Vizza E, Perrone AM, Mereu L, Cela V, Legge F, Hilaris G, Pasciuto T, D'Indinosante M, La Fera E, Certelli C, Bruno V, Kogeorgos S, Fanfani F, De Iaco P, Scambia G, Gallotta V. Comparison Between Laparoscopic and Robotic Surgery in Elderly Patients With Endometrial Cancer: A Retrospective Multicentric Study. Front Oncol 2021; 11:724886. [PMID: 34631553 PMCID: PMC8493293 DOI: 10.3389/fonc.2021.724886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Elderly endometrial cancer (EEC) patients represent a challenging clinical situation because of the increasing number of clinical morbidities. In this setting of patients, minimally invasive surgery (MIS) has been shown to improve surgical and clinical outcomes. The aim of this study was to evaluate the peri-operative and oncological outcomes of EEC patients who had undergone laparoscopic (LS) or robotic surgery (RS). Materials and Methods This is a retrospective multi-institutional study in which endometrial cancer patients of 70 years or older who had undergone MIS for EC from April 2002 to October 2018 were considered. Owing to the non-randomized nature of the study design and the possible allocation biases arising from the retrospective comparison between LS and RS groups, we also performed a propensity score-matched analysis (PSMA). Results A total of 537 patients with EC were included in the study: 346 who underwent LS and 191 who underwent RS. No significant statistical differences were found between the two groups in terms of surgical and survival outcomes. 188 were analyzed after PSMA (94 patients in the LS group were matched with 94 patients in the RS group). The median estimated blood loss was higher in the LS group (p=0.001) and the median operative time was higher in the RS group (p=0.0003). No differences emerged between LS and RS in terms of disease free survival (DFS) (p=0.890) and overall survival (OS) (p=0.683). Conclusions Our study showed that when compared LS and RS, RS showed lower blood losses and higher operative times. However, none of the two approaches demonstrated to be superior in terms of survival outcomes. For this reason, each patient should be evaluated individually to determine the best surgical approach.
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Affiliation(s)
- Giacomo Corrado
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynaecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Liliana Mereu
- Obstetrics and Gynecological Department, Santa Chiara Hospital, Trento, Italy
| | - Vito Cela
- Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Francesco Legge
- Department of Obstetrics and Gynecology, Division of Gynecology, "F. Miulli" General Hospital, Bari, Italy
| | - Georgios Hilaris
- 2nd Department of Gynecologic Oncology, Hygeia Hospital, Marousi, Athens, Greece.,Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University Hospital, Stanford, CA, United States
| | - Tina Pasciuto
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco D'Indinosante
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora La Fera
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Certelli
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Valentina Bruno
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Stylianos Kogeorgos
- 2nd Department of Gynecologic Oncology, Hygeia Hospital, Marousi, Athens, Greece
| | - Francesco Fanfani
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynaecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Gallotta
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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8
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Factors Associated with Same Day Discharge after Laparoscopic Surgery in Gynecologic Oncology. J Minim Invasive Gynecol 2021; 29:114-118. [PMID: 34224874 DOI: 10.1016/j.jmig.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To identify factors associated with same day discharge (SDD) after laparoscopic surgery in gynecologic oncology. DESIGN Retrospective cohort. SETTING Teaching hospital. PATIENTS Total of 800 patients having minimally invasive surgery in the division of gynecologic oncology during a 20-month period. INTERVENTION Minimally invasive surgery cases were reviewed for determinants of SDD to identify factors that could improve the SDD rate. MEASUREMENTS AND MAIN RESULTS During the study period, 800 minimally invasive procedures were performed with a 43.0% SDD rate. Patients who had SDD were younger (52.3 years vs 58.0 years; p <.001), had a lower body mass index (31.1 kg/m2 vs 33.7 kg/m2; p <.001), were less likely to have a malignancy (28.2% vs 55.5%; p <.001), had a lower estimated blood loss (36 vs 72 mL; p <.001), and were more likely to have received an enhanced recovery after surgery protocol (49.8% vs 39.3%; p <.003). Total surgical time was shorter in women with SDD (156 minutes vs 208 minutes) as was total narcotic use in morphine equivalents (MEq) (milligram intravenous MEq, 23.1 mg MEq vs 28.8 mg MEq). SDD was also associated with earlier start time (p <.001). Laparoscopic cases were most likely to have SDD (51.4%) as compared with robotic assisted surgery (16.1%) or minilaparotomy (10.5%). There was a wide range of SDD among surgeons ranging from 19.8% to 56.2% (p <.001). In a multivariate analysis, the factors predicting SDD in order of predictive factors were surgical time (p <.001), recovery time (p <.001), start time (p <.001), surgeon (p <.001), age (p <.001), estimated blood loss (p <.001), and type of surgery (p = .005). CONCLUSION Multiple factors affect SDD. Modifiable factors for SDD include the start time, surgeon preference, and patient expectations for SDD. Given these data, centers should prioritize surgical order by which patients are more likely to go home, and surgeons should analyze their own data with respect to achieving higher SDD rates.
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Korsholm M, Gyrd-Hansen D, Mogensen O, Möller S, Sopina L, Joergensen SL, Jensen PT. Long term resource consequences of a nationwide introduction of robotic surgery for women with early stage endometrial cancer. Gynecol Oncol 2019; 154:411-419. [PMID: 31176554 DOI: 10.1016/j.ygyno.2019.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/16/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The majority of cost-studies related to robotic surgery has a short follow-up and primarily report the costs from the index surgery. The aim of this study was to evaluate the long-term resource consequences of introducing robotic surgery for early stage endometrial cancer in Denmark. METHODS The study included all women with early stage endometrial cancer who underwent robotic, laparoscopic and open access surgery from January 2008 to June 2015. Data was linked from national databases to determine resource consumption and costs from hospital treatments, outpatient contacts, primary health care sector visits, labor market affiliation and prescription of medication. Each patient was observed in a period of 12 months before- and after surgery. The key exposure variable was women who were exposed to robotic surgery compared to those who were not. RESULTS A total of 4133 women underwent surgery for early stage endometrial cancer. The study found additional costs of $7309 (95% confidence interval [CI] 2100-11,620, P = 0.001) per patient in the group exposed to robotic surgery including long-term costs post-surgery compared to the non-exposed group (non-robotic group). When controlling for time trends, the introduction of robotic surgery did not reduce the number of bed days (mean diff -0.42, 95% CI -3.03-2.19, P = 0.752). CONCLUSIONS The introduction of robotic surgery for early stage endometrial cancer did not generate any long-term cost savings. The additional costs of robotic surgery were primarily driven by the index surgery. Any reduction in bed days could be explained by time trends.
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Affiliation(s)
- Malene Korsholm
- Research Unit of Gynecology and Obstetrics, Odense University Hospital, Kloevervaenget 10, 10th Floor, 5000 Odense C, Denmark; Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 5000 C, Denmark; Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J.B. Winsloews Vej 9, 3rd Floor, 5000 Odense C, Denmark; Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, J.B. Winsloews Vej 9B, 1st Floor, 5000 Odense C, Denmark.
| | - Dorte Gyrd-Hansen
- Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, J.B. Winsloews Vej 9B, 1st Floor, 5000 Odense C, Denmark.
| | - Ole Mogensen
- Faculty of Health Institute for Clinical Medicine, Aarhus University and Department of Gynecology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
| | - Sören Möller
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 5000 C, Denmark; Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J.B. Winsloews Vej 9, 3rd Floor, 5000 Odense C, Denmark.
| | - Liza Sopina
- Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, J.B. Winsloews Vej 9B, 1st Floor, 5000 Odense C, Denmark.
| | - Siv L Joergensen
- Research Unit of Gynecology and Obstetrics, Odense University Hospital, Kloevervaenget 10, 10th Floor, 5000 Odense C, Denmark; Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 5000 C, Denmark; Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J.B. Winsloews Vej 9, 3rd Floor, 5000 Odense C, Denmark.
| | - Pernille T Jensen
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 5000 C, Denmark; Faculty of Health Institute for Clinical Medicine, Aarhus University and Department of Gynecology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
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