Uptake and outcomes of robotic gynaecological surgery in England
(2006-2018): a study using administrative hospital data.
Abstract
Objective: To review uptake and outcomes of robotic gynaecological
surgery in England between 1st April 2006 and 31st March 2018. Design:
Retrospective cohort study. Setting: Hospitals of the English National
Health Service (NHS). Population or sample: Women aged 18 years and
above who had elective gynaecological surgery. Methods: Robotic
gynaecological procedures were defined as procedures that used a robotic
minimal access approach for hysterectomy, adnexal surgery and
urogynaecological surgery (sacrocolpopexy, sacrohysteropexy and
colposuspension). Numbers of procedures were reviewed by year and mapped
to the 44 NHS regions. Main outcome measures: Length of stay (nights in
hospital), laparotomy (conversion during primary procedure or after
return to theatre for management of complication), and 30-day emergency
readmission rates by year and procedure type. Results: 527217 elective
gynaecological procedures were performed in the English NHS (1st April
2006 and 31st March 2018), of which 4384 (0.83%) were performed with
robotic assistance (3864 (88%) hysterectomy, 706 (16%) adnexal
surgery, 192 (4%) urogynaecological surgery). There was gradual rise in
uptake but marked geographical variation. Median (IQR) length of stay
(LOS) was 1(1-2) night, laparotomy rate: 0.3% and 30-day emergency
readmission rate: 4.7%. LOS was statistically but not clinically
different across time. Other outcomes did not differ by year.
Conclusions: Robotic gynaecological procedures is increasingly being
used in the English NHS, predominantly for hysterectomy, although
overall in small proportions (2.6% in the most recent study year).
There was wide geographical variation in robotic uptake across England
and overall, outcomes were comparable to those reported in other
countries.