Comparison of Hospital Length of Stay and Readmissions by Surgical Approach in the Treatment of Endometrial Cancer in Washington State, 2008-2011: Robotic Assisted Surgery Compared with Laparoscopy and Laparotomy
Our aims were to determine the trends in surgical approach (laparotomy (XLAP) versus laparoscopy (LS) versus robotic assisted (RAS)) over time for surgically managed endometrial cancer (EC) from 2008-2011, and to determine if length of stay (LOS) and hospital readmissions differed by surgical approach.
We performed a population-based retrospective cohort study of EC patients treated with RAS, LS, or XLAP in Washington State from 2008-2011. We identified patients treated at hospitals that provided all three surgical approaches using the Comprehensive Hospital Abstract Reporting System (CHARS. We compared the proportion of each approach from 2008 to 2011. We assessed the association between surgical approach and LOS using linear regression to estimate change in mean number of days and 95% confidence intervals (CI), and the association between approach and any readmission within 90 days, as well as stratified by early (0-30 days), intermediate (31-60 days), and late readmission (61-90 days) using logistic regression to estimate odds ratios (OR) and 95% CI, adjusting for the year of surgery.
We identified 2,258 patients who underwent surgical treatment of EC, with 1,003 RAS, 284 LS, and 971 XLAP. Patients undergoing XLAP had more comorbidities than those who had RA or LS (CCI ≥2 12.4%, 8.6% and 7.4% respectively. p<0.01). Obesity rates were similar for all groups at 31%. Comparing 2008 to 2011, cases performed by LS and XLAP significantly declined (32.3% to 6.5% and 55.6% to 26.5% respectively) as use of the RA approach increased (12.0% to 66.9%). Mean LOS was shorter for both RA (-2.7days; 95% CI: -2.9, -2.5 days) and LS (-2.5 days; 95% CI: -2.8, -2.2 days) compared to XLAP. Risk of any readmission 0- 90 days from discharge for patients undergoing RAS was half as likely compared to XLAP (OR : 0.5 95% CI: 0.3, 0.6) but not different for LS vs XLAP (OR=0.7; 95% CI: 0.5, 1.1). Early and intermediate-timed readmission for RAS vs XLAP were 60% less likely (OR=0.4; 95% CI: 0.3, and OR=0.4; 95% CI: 0.2, 0.8 respectively) with no difference in late readmissions (OR=1.0; 95% CI: 0.5, 2.1).
Patients who underwent either RA or LS surgery for the treatment of EC had shorter LOS, however only those undergoing RAS had a lower risk of readmission compared to XLAP. Robotic surgery should be viewed as an alternative to laparoscopy in the treatment of EC, and preferable to XLAP.