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

Thesis (Master's)--University of Washington, 2015Objectives: 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. Methods: 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. Results: 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