miércoles, 10 de febrero de 2016

Women Who Undergo Robotically Assisted Hysterectomy More Likely To Need Follow-Up Care: AHRQ Study

Women who had a hysterectomy (removal of the uterus) by robotically assisted surgery were 24 percent to 32 percent more likely to return to the hospital for follow-up care, whether for readmission, emergency department care or an outpatient department procedure, according to a new AHRQ study. Using 2011 data from AHRQ’s Healthcare Cost and Utilization Project, researchers compared hospital-based revisit rates for robotically assisted and conventional hysterectomy within 30 days of initial discharge. Women ages 30 and older with nonmalignant conditions were studied, representing more than 86,000 inpatient hysterectomies from eight states and more than 29,000 outpatient hysterectomies from four of those states. Common reasons for follow-up care after a robotically assisted hysterectomy included surgical complications, hospital-acquired infections, postoperative pain, pulmonary embolisms and digestive disorders. Among other findings, the study showed that robotically assisted hysterectomies were more frequently performed in ambulatory settings (33 percent) than in hospital inpatient settings (11 percent). The study, “Hospital Revisits Within 30 Days After Conventional and Robotically Assisted Hysterectomy,” and abstract were published in the January 12 issue of Medical Care.

2016 Jan 12. [Epub ahead of print]

Hospital Revisits Within 30 Days After Conventional and Robotically Assisted Hysterectomy.

Friedman B1, Barbash GI, Glied SA, Steiner CA.

Author information

Abstract

OBJECTIVES:

To compare the rates of hospital readmissions, emergency department, and outpatient clinic visits after discharge for robotically assisted (RA) versus nonrobotic hysterectomy in women age 30 or more with nonmalignant conditions.

DATA SOURCES:

Discharges for 2011 for 8 states (CA, FL, GA, IA, MO, NE, NY, TN) (>86,000 inpatient hysterectomies) were drawn from the statewide databases of the Healthcare Cost and Utilization Project. Data from 4 of these states were used to study revisits after 29,000 outpatient hysterectomies.

METHODS:

Matched pairs of patients were constructed with propensity scores derived from each patient's age group, severity of illness, insurance coverage, and type of procedure. Both the full set of revisits and a set limited to diagnoses for revisits judged in other research to be related to the initial surgery (about 70% of all revisits) were analyzed. The analyses were repeated with an instrumental variables regression design.

KEY RESULTS:

Using the propensity score matched pairs, revisits, and specifically readmissions, after inpatient hysterectomy were greater for RA versus non-RA patients (relative risk of readmission=124%, P<0.01). Similar results were found for readmissions after outpatient hysterectomy, and readmissions after inpatient hysterectomy for the restricted set of related revisits. In the method with instrumental variables, RA was associated with an increase of 32% in the likelihood of any revisit (P<0.01).

CONCLUSIONS:

Using 2 different methods to control for selection, this study found higher rates of revisits among women undergoing RA versus non-RA hysterectomy for benign conditions. While selection bias cannot be ruled out completely in an observational study, the study supports broader use of revisits for analyses of outcomes of hysterectomy.