Extended Length of Stay After Robotic-Assisted Hysterectomy: Association with Uterine Weight and Other Risk Factors

Abstract

Abstract

Background: Robotic-assisted hysterectomy (RH) has the same clinical benefits as laparoscopy and offers surgeons additional benefits. However, RH-related costs are high and its clinical benefits have not been shown to be better than those achieved with laparoscopy. A key cost factor is the length of (hospital) stay (LOS). Objective: The aim of this study was to identify the relationship between uterine weight and LOS following RH and potential risk factors for extended LOS. Materials and Methods: This study involved a retrospective cohort of all RHs performed in a midwestern tertiary-care teaching hospital and its suburban affiliates, from January 2011 to December 2012. Data were collected using Current Procedural Terminology codes. The current authors examined if any of several variables were associated with uterine weight, using Spearman's correlation for continuous variables and Wilcoxon's rank sum or Kruskal-Wallis test for categorical variables. Comparison of variables between patients who did and who did not have a LOS>1 day was performed using a Wilcoxon rank sum test for continuous variables and a Chi-square or Fisher's exact test for categorical variables. Those that were associated with both uterine weight and LOS were considered as potential confounders and were included in the logistic regression model. The adjusted odds ratio (OR) for a 100-g increase in uterine weight was calculated. Results: Of 239 patients who underwent RH, 48 (20%) had a LOS>1 day. Uterine weight was significantly greater among patients with LOS>1 day (483 g versus 337 g; p=0.008). Patients who had LOS>1 day had a greater estimated blood loss (EBL; means: 178 mL versus 95 mL; p=0.006) and a significantly longer procedure duration (means: 236 minutes versus 168 minutes; p<0.005), compared to patients with LOS=1. In addition, patients with LOS>1 day had higher baseline pain scores (4.5 versus 3.2; p=0.003). Number of ports and oophorectomy were both significantly associated with LOS. For a 100-g increase in uterine weight, there was 1.12 times the odds of having LOS>1 day (OR=1.12; 95% confidence interval: 1.02, 1.21). After controlling for procedure duration, EBL, number of ports, transfusion rates and oophorectomy, the adjusted OR (aOR) was not significant (aOR=1.0; CI: 0.89, 1.12). Conclusions: When adjusted for procedure duration, EBL, number of ports, transfusion rates, and oophorectomy, uterine weight was not associated with LOS after RH. Larger studies are needed to explore further the associations among procedure duration, EBL, baseline pain scores, oophorectomy, and number of ports used with prolonged LOS after RH. Pain management seemed to be the single greatest indication for increased LOS after RH. (J GYNECOL SURG 32:19)