A. Clements

Reducing readmissions after robotic surgical management of endometrial cancer:A potential for improved quality care

OBJECTIVE To describe readmission patterns after robotic surgery for endometrial cancer and identify risk factors for readmission within 90 days of discharge. METHODS Patients with endometrial cancer who underwent robotic surgical management at an academic institution from 2006 to 2010 were identified. Patient characteristics, intraoperative data, and postoperative complications were analyzed. Students t-test and Fishers exact test were used to compare patients readmitted within 90 days to those who were not. RESULTS Three hundred ninety-five patients were included. Thirty (7.6%) were readmitted within 90 days of surgical discharge. Length of stay greater than one day (40.0% vs. 23.0%, p=0.04) and postoperative complication (63.3% vs. 13.4%, p<0.01) were associated with readmission. The median interval to readmission was 9.5 days and median duration of subsequent hospitalization was 2.5 days. Fever (31.3%) and workup for vaginal drainage (25.0%) were the most common reasons for readmission. Only 2 of the 10 patients readmitted with fever had culture-proven infection, and no patients readmitted for vaginal drainage had a confirmed urinary tract injury. Of the 30 patients readmitted, 5 required a second operation - 3 for vaginal cuff dehiscence and 2 for port site hernia. CONCLUSIONS Robotic surgery for endometrial cancer was associated with a 7.6% readmission rate. The most common reasons for readmission, fever and evaluation for urinary tract injury, were frequently not associated with severe illness. This supports additional education to consider raising the threshold for readmission by using more widespread outpatient evaluation for the potential complications of robotic endometrial cancer surgery.

Is selective lymphadenectomy more cost-effective than routine lymphadenectomy in patients with endometrial cancer?

OBJECTIVE The objective of this study is to determine the cost-effectiveness of two strategies in women undergoing surgery for newly diagnosed endometrial cancer. METHODS A decision analysis model compared two surgical strategies: 1) routine lymphadenectomy independent of intraoperative risk factors or 2) selective lymphadenectomy for women with high or intermediate risk tumors based on intraoperative assessment including tumor grade, depth of invasion, and tumor size. Published data were used to estimate the outcomes of stage, adjuvant therapy, and recurrence. Costs of surgery, radiation, and chemotherapy were estimated using Medicare Current Procedural Technology codes and Physician Fee Schedule. Cost-effectiveness ratios were estimated for each strategy. Sensitivity analyses were performed including an estimate for lymphedema for patients that underwent a lymphadenectomy. RESULTS For 40,000 women diagnosed annually with endometrial cancer in the United States, the annual cost of selective lymphadenectomy is

Robotic Hysterectomy for Endometrial Cancer in Obese Patients With Comorbidities: Evaluating Postoperative Complications.

1.14 billion compared to

Is the progression free survival advantage of concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin in patients with advanced cervical cancer worth the additional cost? A cost-effectiveness analysis

1.02 billion for routine lymphadenectomy. The selective lymphadenectomy strategy cost an additional

WWP2 and its association with PTEN in endometrial cancer.

123.3 million. Five-year progression-free survival was 85.9% in the routine strategy compared to 79.3% in the selective strategy. Treatment cost

Omitting Preoperative Lymphoscintigraphy Does Not Decrease Sentinel Lymph Node Detection Rate in Vulvar Cancer

6349 more per survivor in the selective strategy compared to routine strategy (

Abstract 1992: Is the ubiquitin ligase WWP2 playing a role in PTEN degradation in endometrial cancer.

36,078 vs.

Predicting Inpatient Stay Lasting 2 Midnights or Longer After Robotic Surgery for Endometrial Cancer

29,729). These results held up under a variety of sensitivity analyses including costs due to lymphedema which were higher in the routine lymphadenectomy strategy compared to the selective lymphadenectomy strategy (

Access to gynecologic oncologists in Ohio in 2017: The role of the patient portability and Affordable Care Act

10 million vs.

Risk of complications after robotic hysterectomy for endometrial cancer in obese patients with preoperative comorbidities

7.75 million). CONCLUSIONS A strategy of selective lymphadenectomy based on intraoperative risk factors for patients with endometrial cancer was less cost-effective than routine lymphadenectomy even when the impact of lymphedema was considered.