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Hospital Revisits Within 30 Days After Conventional and Robotically Assisted Hysterectomy

Friedman, Bernard, PhD; Barbash, Gabriel I., MD, MPH; Glied, Sherry A., PhD; Steiner, Claudia A., MD, MPH

doi: 10.1097/MLR.0000000000000482
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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.

*Agency for Healthcare Research and Quality, Rockville, MD

Tel Aviv Sourasky Medical Center and Weitzmann Institute of Science, Rehovot, Israel

Wagner School of Public Service, New York University, New York, NY

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The views expressed in this article are those of the authors and do not necessarily represent those of the Agency for Healthcare Research and Quality.

The authors declare no conflict of interest.

Reprints: Bernard Friedman, PhD, Center for Organization, Delivery and Markets, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. E-mail: econobarry@gmail.com.

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