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Specchia ML, Arcuri G, Di Pilla A, La Gatta E, Osti T, Limongelli P, Scambia G, Bellantone RDA. The value of surgical admissions for malignant uterine cancer. A comparative analysis of robotic, laparoscopic, and laparotomy surgery in a university hospital. Front Public Health 2022; 10:920578. [PMID: 36276379 PMCID: PMC9582355 DOI: 10.3389/fpubh.2022.920578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/01/2022] [Indexed: 01/22/2023] Open
Abstract
Background Robotic surgery for malignant uterine cancer raises issue of economic sustainability for providers. The objective of this study was to assess the value of surgical admissions for malignant uterine cancer in a University Hospital through an analysis of their costs and outcomes by comparing three different surgical approaches (laparotomy, laparoscopic, and robotic surgery). Methods Hospitalizations between 1 January 2019 and 31 October 2021 for malignant uterine cancer surgery were selected and stratified. For each surgical approach, mean values (with 95% confidence intervals, CI) were calculated for cost items. Moreover, 30-day readmission frequency was calculated for the three approaches compared to each other. ANOVA and Student's t-test and relative risk (RR) were used for statistical analysis. A break-even analysis was carried out by evaluating the volume of robotic and non-robotic surgical admissions. Results A total of 1,336 hospitalizations were included in the study, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery, compared to laparoscopic and laparotomy ones, showed a statistically significant difference (p < 0.001) in the economic margin, which was largely negative (-1069.18 €; 95%CI:-1240.44--897.92 €) mainly due to devices cost, and a lower percentage of 30-day readmissions (1.4%; 95%CI: 0.2-2.6%), with a statistically significant difference only vs. laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 €-1852.66 €) without a significant difference for 30-day readmissions. Break-even analysis showed that, on average, for each malignant uterine cancer elective surgery performed laparoscopically, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23-2.06). Conclusion Break-even analysis could be a useful tool to support hospital management in planning and governance of malignant uterine cancer surgery. Systematic application of this tool will allow defining over time right distribution of robotic, laparoscopic, and laparotomy surgeries' volumes to perform to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery. Concerning research, this study paves the way for a multicentric study, the extension of outcomes of malignant uterine surgery to be considered and assessed, and the future inclusion of other therapeutic interventions in the analysis.
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Affiliation(s)
- Maria Lucia Specchia
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Arcuri
- Health Technologies and Innovation Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Di Pilla
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy,*Correspondence: Andrea Di Pilla
| | - Emanuele La Gatta
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Osti
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Prospero Limongelli
- Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy,Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Rocco Domenico Alfonso Bellantone
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Translational Medicine and Surgery Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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