Research Unit of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.
Research unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.
Acta Obstet Gynecol Scand. 2021 Oct;100(10):1830-1839. doi: 10.1111/aogs.14237. Epub 2021 Aug 11.
The aim of the study was to investigate whether robotic-assisted surgery is associated with lower incremental resource use among obese patients relative to non-obese patients after a Danish nationwide adoption of robotic-assisted surgery in women with early-stage endometrial cancer. This is a population-based cohort study based on registers and clinical data.
All women who underwent surgery (robotic, laparoscopic and laparotomy) from 2008 to 2015 were included and divided according to body mass index (<30 and ≥30). Robotic-assisted surgery was gradually introduced in Denmark (2008-2013). We compared resource use post-surgery in obese vs non-obese women who underwent surgery before and after a nationwide adoption of robotic-assisted surgery. The key exposure variable was exposure to robotic-assisted surgery. Clinical and sociodemographic data were linked with national register data to determine costs and bed days 12 months before and after surgery applying difference-in-difference analyses.
In total, 3934 women were included. The adoption of robotic-assisted surgery did not demonstrate statistically significant implications for total costs among obese women (€3,417; 95% confidence interval [CI] -€854 to €7,688, p = 0.117). Further, for obese women, a statistically significant reduction in bed days related to the index hospitalization was demonstrated (-1.9 bed days; 95% CI -3.6 to -0.2, p = 0.025). However, for non-obese women, the adoption of robotic-assisted surgery was associated with statistically significant total costs increments of €9,333 (95% CI €3,729-€1,4936, p = 0.001) and no reduction in bed days related to the index hospitalization was observed (+0.9 bed days; 95% CI -0.6 to 2.3, p = 0.242).
The national investment in robotic-assisted surgery for endometrial cancer seems to have more modest cost implications post-surgery for obese women. This may be partly driven by a significant reduction in bed days related to the index hospitalization among obese women, as well as reductions in subsequent hospitalizations.
本研究旨在探讨在丹麦全国范围内将机器人辅助手术应用于早期子宫内膜癌女性后，与非肥胖患者相比，肥胖患者的增量资源使用是否较低。这是一项基于登记和临床数据的基于人群的队列研究。
所有 2008 年至 2015 年间接受手术（机器人、腹腔镜和剖腹）的女性均被纳入研究，并根据体重指数（<30 和≥30）进行分组。机器人辅助手术在丹麦逐渐引入（2008-2013 年）。我们比较了肥胖和非肥胖女性在全国范围内采用机器人辅助手术后的术后资源使用情况。主要暴露变量是接受机器人辅助手术的情况。临床和社会人口统计学数据与国家登记数据相关联，以确定手术前 12 个月和手术后的成本和床位天数，并应用差异分析。
共纳入 3934 名女性。肥胖女性的机器人辅助手术的采用并未显示出总费用的统计学显著影响（€3417；95%置信区间[CI]-€854 至 €7688，p=0.117）。此外，对于肥胖女性，与索引住院相关的床位天数显著减少（-1.9 天；95%CI-3.6 至-0.2，p=0.025）。然而，对于非肥胖女性，机器人辅助手术的采用与总费用的统计学显著增加有关，增加了€9333（95%CI €3729-€14936，p=0.001），且与索引住院相关的床位天数没有减少（+0.9 天；95%CI-0.6 至 2.3，p=0.242）。
丹麦对机器人辅助手术治疗子宫内膜癌的全国性投资似乎对肥胖女性的术后成本影响较小。这可能部分是由于肥胖女性与索引住院相关的床位天数显著减少，以及随后的住院次数减少所致。
